Effect Size and Confidence

Intervals
Unit 5 : Asynchronous
K Benker MD MPH

Session #101: AS 1

Learning Objectives

1. To interpret an effect size with a confidence

interval

Effective, but how effective?

How much will eating
more fish lower the
risk of cardiovascular
death?
Is diuretic A better (more effective) than diuretic B in treating
hypertension?
Is evolocumab (a monoclonal antibody) more effective than statins in
reducing LDL?
...

Measure the effect size!

Simple Concept
Relative risk (RR), i.e. of death

Cohort studies
Randomized controlled trials

Subtract risk of death with intervention from risk

without intervention
Ex: 7 deaths per 100 person-years without X

3 deaths per 100 person-years with X

Effect size = 4 per 100 person-years
Expressed as percent reduction
4/7 reduction = 57% reduction
Or as risk ratio = 7/3 = 2.33

6
4
2
0

Effect size

Risk ratio (RR)

All-Cause Mortality Reduction in Patients with CAD
With 95% Confidence Intervals
RCT

Prospective cohort

---

0.64 (0.58 0.71)

Physical activity

0.76 (0.59- 0.96)

0.80 (0.78 0.83)

Less saturated fat

0.98 (0.81 1.18)

0.64 ( 0.46 0.88)

Fish oil

0.88 ( 0.69 1.11)

0.81 (0.69 0.94)

Smoking cessation

From Iestra et al, Circulation, 2005

Remember . . .
Ratio = a/b
The result is a multiple of 1
Ex: 7/4 = 1.75
Ex: 1037/543 = 1.91

If the confidence interval includes 1

Not statistically significant
Risk Ratio

95% C.I.

Physical activity

0.76

(0.59- 0.96)

Less saturated fat

0.98

(0.81 1.18)

Statistically
significant
NOT statistically
significant

 Can you interpret an effect size with

confidence intervals?