Prevalence Ratio in Cross-Sectional Study

Lead Author(s): Jeff Martin, MD

Definition of Prevalence Ratio

Prevalence of Disease in Exposed and Unexposed

Meaning of Prevalence Ratio

Strength of Association

Ratio Based on Probabilities

Study Reporting Prevalence Ratios

Reference

Definition of Prevalence Ratio

The ratio of the proportion of the persons with disease over the proportion with
the exposure.

Prevalence of Disease in Exposed and Unexposed

In the 2x2 table below the proportion of the persons with disease is calculated in the group
with theexposure and separately in the group without the exposure.

a/a+b (circled in red) is the prevalence of disease among the exposed persons

c/c+d (circled in blue) is the prevalence of disease among the non-exposed.

Since this is a cross-sectional study, both are prevalence.

To compare these two prevalences, we can form a ratio with one over the other to get a
prevalence ratio of disease in the exposed and unexposed.

Meaning of Prevalence Ratio

If the prevalence is the same, the ratio will equal 1.0.

If disease prevalence is higher in those with the exposure (placed on top in the
ratio), the ratio will be greater than 1.0.

If the prevalence is lower in those with the exposure, the ratio will be l ess than
1.0.

Strength of Association
How much greater or less than 1.0 is a measure of the strength of the
association between the exposure and the disease.
This kind of measure of association is known as a ratio measure.

Ratio Based on Probabilities

In the above table:

So a/a+b and c/c+d = probabilities of disease

PR is ratio of two probabilities

The proportion with prevalent disease among those exposed is the probability of prevalent
disease among the exposed, and similarly for the unexposed. We are making this point to
distinguish a ratio based on probabilities from a ratio based on odds.

Study Reporting Prevalence Ratios

An example of the prevalence ratio can be found in Ross:
"Overall, HSV2 prevalences at follow-up were 11.9% in male and 21.1% in female
participants, with adjusted prevalence ratios of:

0.92 (CI 0.69, 1.22) and

1.05 (CI 0.83, 1.32), respectively."

This is a publication from a community-randomized trial in Tanzania.

The main biological outcomes were the incidence of HIV infections during the trial and the
prevalence of HSV2 infection at the end of the trial in the:

intervention and

control groups

(20 communities were randomized, 10 to each group).

HSV2 was measured only once, cross-sectionally, at the end of the trial and

hence the ratio of the prevalence in the intervention and control groups is reported
correctly as a prevalence ratio.

Reference
Ross, D. A., Changalucha, J., Obasi, A. I., Todd, J., Plummer, M. L., Cleophas-Mazige, B.,
et al. (2007). Biological and behavioural impact of an adolescent sexual health intervention
in Tanzania: a community-randomized trial. Aids, 21(14), 1943-1955.