Relative and

Attributable Risks
 Absolute Risk
• Involves people who contract disease
due to an exposure
• Doesn’t consider those who are sick
but haven’t been exposed
Calculating Excess Risk
 Relative Risk

Definition:
A measure of the strength of
association based on prospective
studies (cohort studies).
Determining Relative Risk
Interpreting Relative Risk
Relative Risk Calculations
Relative Risk Calculations (cont.)
 Relative Risk in
Case-Control Studies
• Can’t derive incidence from case-
control studies
Begin with diseased people (cases) and
non-diseased people (controls)
• Therefore, can’t calculate relative risk
directly
• But, we can use another method
called an odds ratio
 Odds Ratio in
Prospective (Cohort) Studies
 Odds Ratio in
Case-Control Studies
 Odds Ratio in
Case-Control Studies (cont.)
When is the Odds Ratio a Good
Estimate of Relative Risk?

• When cases are representative of

diseased population
• When controls are representative of
population without disease
• When the disease being studied
occurs at low frequency
 REMEMBER !!!
• An odds ratio is a useful measure of
association
• In a cohort study, the relative risk can
be calculated directly
• In a case-control study the relative
risk cannot be calculated directly, so
an odds ratio is used instead
 Attributable Risk

Definition:
The amount of disease that can be
attributed to a certain exposure.
Concept of Attributable Risk
Attributable Risk for an
Exposed Group
Attributable Risk for an
Exposed Group (cont.)
From previous relative risk example:

OR, expressed as a proportion:

 Calculation for Proportional
Incidence in Total Population
First calculate A-R for
group from
Formulas 11.1 & 11.2
(previous slide),
then use Formula
11.3

For proportion of the

incidence in the
total population, use
Formula 11.4
 Calculations for
Attributable Risks (cont.)
 Summary
• Relative risk and odds ratio are important as
measures of the strength of association
Important for deriving causal inference
• Attributable risk is a measure of how much
disease risk is attributed to a certain exposure
Useful in determining how much disease can
be prevented
• Therefore:
Relative risk is valuable in etiologic studies
of disease
Attributable risk is useful for Public Health
guidelines and planning