Nahda college-Medicine Programme

Advanced epidemiology course

Measures of
Association
By: Fadwa M. S. Moahmmed

??What are they

A measure of association quantifies
the relationship between exposure
and disease among the two groups.
Exposure could be:
characteristics of persons
Activities
Conditions

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Measures of association
:include
Relative Risk (Risk Ratio)

(RR)

Odds Ratio (OR)

Rate Ratio

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Risk ratio
Compares the risk of a health event
(disease, injury, risk factor, or death)
among one group [exposed] with the
risk among another group [nonexposed].

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The formula for risk ratio (RR) is:

Risk of disease (incidence proportion, attack
rate) in group of primary interest
Risk of disease (incidence proportion, attack
rate) in comparison group

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:Interpretation of RR
If > 1

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RR calculation: Example
In an outbreak of tuberculosis among
prison inmates in South Carolina in
1999, 28 of 157 inmates residing on
the East wing of the dormitory
developed tuberculosis, compared
with 4 of 137 inmates residing on the
West wing.11
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General Format and Notation for a Two-by-Two Table

Total

Not
disea Disea
sed
sed

a+b

Expos
ed

c+d

Not
expos
ed

a+b+
c+d

b+d

a+c

Total

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A Two-by-Two Table in our example

157
137
294
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Didn
't
deve
lop
TB
b=
129
d=
133
262

Deve
lope
d TB

a = East
28 Wing
c = 4 West
Wing
32 Total
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To calculate the risk ratio, first

calculate the risk or attack rate for
each group. Here are the formulas:
Attack rate for exposed = a / a+b
Attack rate for unexposed = c / c+d

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For this example:

Risk of tuberculosis among East wing
residents = 28 / 157 = 0.178 = 17.8%
Risk of tuberculosis among West wing
residents = 4 / 137 = 0.029 = 2.9%
The risk ratio is simply the ratio of
these two risks:
Risk ratio = 17.8 / 2.9 = 6.1

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Quiz
In an outbreak of varicella
(chickenpox) in Oregon in 2002,
varicella was diagnosed in 18 of 152
vaccinated children compared with 3
of 7 unvaccinated children. Calculate
the risk ratio.

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Solution
Risk of varicella among vaccinated
children
11.8% = 0.118 = 152 / 18 =
Risk of varicella among unvaccinated
children = 3 / 7 = 0.429 = 42.9%
Risk ratio = 0.118 / 0.429 = 0.28

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Odds ratio

It quantifies the relationship between

an exposure with two categories and
health outcome.

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??What is the Odds

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:Interpretation of OR
If > 1

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Quiz
In an outbreak of tuberculosis among
prison inmates in South Carolina in
1999, 28 of 157 inmates residing on
the East wing of the dormitory
developed tuberculosis, compared
with 4 of 137 inmates residing on the
West wing.11
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Solution:

TB
TB
+ ve - ve
157 b = a = East
129 28 Win
Odds ratio = ad /
g
bc
137 d = c = Wes
= (28 x 133) /
133 4
t
(129 x 4) = 7.2
Win
g
294 262 32 Total
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Rate Ratio
A rate ratio compares the incidence
rates, person-time rates, or mortality
rates of two groups.
The two groups are typically
differentiated by demographic
factors or by exposure to a suspected
causative agent.
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Calculation of Rate Ratio

Rate ratio =

Rate for group of primary interest

Rate for comparison group

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:Interpretation of Rate Ratio

If > 1

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Example:

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References:

1. Principles of epidemiology, 3rd

edition.
2. A pocket guide to epidemiology.

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