ASSESSING

ASSOCIATIONS
 Assessing strength of association:

• If +Ve assoc. exists between exposure and

disease then incidence in exposed will be greater
than in non-exposed.
• The incidence of a disease in a pop. is the
Absolute Risk.
• To decide whether there is an associated risk we
calculate excess risk between exposed and
unexposed (Attributable).
 Assessing strength of association:

• Relative Risk : Measures strength of Association.

- This is the ratio of risk in exposed to the
risk of disease in unexposed.
- R.R. = Risk in exposed
Risk in un-exposed
 RELATIVE RISK

DISEASE

EXPOSURE + - TOTAL

+ a b a+b

- c d c+d

TOTAL a+c b+d a+b+c+

d
 Smoking and CHD

CHD CONTROLS

Smoke 112 176 288

Don’t 88 224 312

smoke
200 400 600
 ODDS RATIO (O.R.):

• For Case-Control studies cause no-incidence. So cannot

calculate R.R.

- O.R. is also called relative ODDS.

- ODDS is probability that event will occur i.e.

one will get disease, to probability that event will not
occur i.e. one will not get disease.
 ODDS RATIO

• If one has 60% probability of winning (W), then

has 40% not winning (NW).
• Probability of losing = (1- W) = (100-60%).
- Odds of WINNING
is 60 = 1.5
40
• ODDS of an event is the ratio of number of ways it
can occur to the number of ways it cannot occur.
 ODDS RATIO

ODDS = No. of ways event can occur

No. of ways it cannot occur
 ODDS RATIO
Disease Odds of disease
having exposure
Exposure
a b a+b
Odds of
exposure having c d c+d
disease

a+c b+d a+b+c+

d
 ODDS RATIO

-The ODDS of getting disease in exposed

=a
b
- The ODDS of getting disease in unexposed = c
d
ODDS RATIO = (a/b)/(c/d) = axd
cxb
(Cross-products Ratio)
 ODDS RATIO

- Often the R.R. is very close to the OR so

the two may be used as through they are the
same.
 Attributable Risk (A.R.)

- Attributable Risk – the amount of disease that

can be attributed to a certain exposure.

• AR =
(Incid. in expo.) – (Incid. in Unexpo).
 Attributable Risk (A.R.)

• Could ask, what prop. of disease in exposed persons is due to

exposure or proportion of Incidence attributable to Exposure

A.R.
= (Incidence in Exposed) – (Incidence in non-exposed)

A.R. %

= (Incidence in Exposed) – (Incidence in non-exposed) X 100

Incidence in Exposed
 Population Attributable Risk (A.R.)

• -In population, the impact of removing exposure

can be calculated as:

• A.R.
= (Incidence in total pop) – (Incidence in non-exposed)
Incidence in total pop.
 ATTRIBUTABLE RISK

•A.R { Incidence in Exposed

} } Incidence in
Unexposed