Answers

to TA Handout Questions for Exam 1

1. Comparing exposures in disease outbreak requires that you set up tables for calculating
the relative risk for each exposure:

You know that 120 people attended the banquet and 90 got sick. This allows you to
determine A, B, C, and D for each exposure.

Disease No disease
Beef 50 10
No beef 40 20
RR = (AD/BC) = (50*20)/(10*40) = 2.5

Disease No disease
Chicken 85 15
No chick 5 15
RR = 17

Disease No disease
Veg 35 5
No veg 55 25
RR = 3.2

Exposure to chicken increased the odds of becoming ill more than exposure to either beef
or vegetables and is therefore the most likely cause of the outbreak.

For your information (and hopefully not increasing confusion): The type of study you are
dealing with in these types of questions is determined has to do with the population under
consideration.
1. If the population is small and well-defined, such as in the example above where you know
that only 120 people attended and all 120 people are being surveyed for exposure and disease
outcome it is a cohort study. Participants are grouped according to their exposure to a
factor and disease status is evaluated. Thus you calculate risk ratio of attack rates. This is
the incidence of disease in exposed subjects (A/B) : the incidence of disease in unexposed
subjects (C/D). Finding the ratio of the two, you are left with AD/BC.
2. If the outbreak is in a community that is not well-defined, for example a hepatitis outbreak
in a city that has people travelling in and out you will not be able to survey everyone with
possible exposures. In this case you are sampling from the total population and will group
participants according to their disease status and then evaluate their exposures. In this case,
it is a case-control study, and you will calculate the odds ratio with AD/BC.

You will notice that the outcome of these calculations will be the same, although the
reasoning behind the two calculations is slightly different.

2.
Iexposed = 0.06
Iunexposed = 0.001
Itotal = 0.01

RR = Ie/Io = 0.06/0.001 = 60
AR = Ie Io = 0.059 = 5.9%
AR% = AR/Ie = 0.059/0.06 = 98.3%
PAR = It Io = 0.009 = 0.9%
PAR% = PAR/It = 0.009/0.01 = 0.9 = 90%

3.
a. Some biases that may come into play: exposure-suspicion bias, possible prevalence-
incidence (Neyman) bias, recall bias (at least among the living participants). There is also
quite a few confounding factors that can be identified. There may be regional, income,
ethnic, racial, gender, or age preferences in beer brand choices these should all be
controlled for.

b. You are calculating an odds ratio in this problem because it is a cohort study.
Death Survival
Bud 60 15
No Bud 40 85

OR = 5100/600 = 8.5

c. This question is problematic your friend is not at risk of having cirrhosis if he is
concerned with the results of this study he has cirrhosis and is concerned with his risk of
dying from it. Thus the friends question should read: If I have cirrhosis, what fraction of
my risk of dying from it is attributable to my Bud drinking? (This is a picky point, but its
important to be aware of what information you can actually determine from a study and
what you cannot.)

The question is asking an individuals attributable risk percent:

AR% = (RR-1)/RR = (8.5-1)/8.5 = 88%

Therefore, 88% of his risk of dying from cirrhosis is due to drinking Bud over some other
kind of beer.

d. This is asking a populations attributable risk:

PAR% = Pe(RR-1)/[Pe(RR-1)] + 1 = (0.65*7.5) / [(0.65*7.5)+1] = 82.9%