Relative Risk

Odds Ratio
 Number of cases
 Incidence To describe disease frequency in a
 Prevalence population
 Proportional mortality
 Relative risk
 Odds ratio To analyse the association
 Proportional mortality ratio between the disease and its risk
 Standardized ratios factors
 Attributable risk
 Life years lost
(To quantify the impact of a
 Disability adjusted life year (DALY) disease or a risk factor in a
 Quality adjusted life year (QALY) population)
 Numbers needed to treat
 Etc.
 In epidemiology we are interested in the probability of
developing a disease and those environmental, individual, social,
etc factors which influence this.
 We want to know if there is an association between these factors
and the disease.

Describe disease frequency in a population

Compare disease frequency between populations

Association = increased probability of developing a

disease in the presence of the influencing factor
(risk factor)
 We manipulate epidemiological data to extract
additional insights and understand the
relationship between the disease and its risk
factors.
Risk (= the probability that an event will occur
number of times an event is likely to occur
= Proportion
total number of events

(probability ~ risk) ~ (frequency ~ incidence)

Odds (= chance)
Odds are the chances of being exposed (or diseased) in a
population: exposed (cases)/rest
number of times an event is likely to occur
= Ratio
number of times an event is likely not to occur
Risk: Likelihood (probability) of developing a disease or
dying.
Risk factor: A factor associated with an increased
probability of developing a disease

Sick
Risk factor
exposure
Healthy
No risk factor Sick

Healthy
 Diseased person

Healthy person

Risk factor

2 by 2 table:

Disease Disease Total

+ -
Exposure + A B A+B

Exposure - C D C+D

Total A+C B+D A+B+C+D

RR is a ratio of two risks (incidence rates): Incidence of the disease
in the population with risk factor divided by the incidence of the
disease in the population without risk factor.
Disease Disease Total
+ -
Risk factor A B A+B
+
Risk factor C D C+D
-
Total A+C B+D A+B+C+D

Incidence (exposed) A / (A+B)

RR= =
Incidence (non-exposed) C / (C+D)
 Relative Risk (RR)

It shows if the disease is more frequent in the exposed population

than in the non-exposed population.

Incidence (exposed) A / (A+B)

RR= =
Incidence (non-exposed) C / (C+D)
 Itis the prime measure of association in
epidemiology.

 It measures the size of the effect of the risk factor on

disease rates, so it indicates the strength of the
association.

 RR can never be calculated from case-control studies

which do not give incidence data!
If the 95% confidence interval contains 1,
the result is not statistically significant.
Calculate RR:

Follow up 100 smokers and 100 non-smokers. After 20 years

25 people from the smoker group developed lung cancer
and 10 from the non-smoker group.

 Q1: Create a 2 x 2 table and interpret the data

 Q2: According to the study what is the relative risk of
developing lung cancer if someone smokes?
 Lung Cancer Lung Cancer Total
+ -
Smoking + 25 75 100

Smoking - 10 90 100

Total 35 165 200

RR = 25/100 = 2.5
10/100
OR is a ratio of two odds: The odds of being exposed in the diseased
population divided by the odds of being exposed in the healthy
population. (exposure OR)
/OR the odds of developing the disease in the exposed population divided by the odds of developing a
disease in the non-exposed population. (disease OR) /

Disease Disease Total

+ -
Risk factor A B A+ B Odds (diseased) A/C AxD
+ OR= = =
Risk factor C D C+D
Odds (non-diseased) B/D BxC
-
Total A+ C B+D A+ B+ C+
D
 It shows if the chance of being exposed to a risk factor is
higher in the diseased population than in the non-diseased
(healthy) population (exposure OR).
. /It shows if the chances of developing the disease in the exposed population is
higher than in the non-exposed population. (disease OR)/

If OR>1 → Positive association = Risk factor

If OR<1 → Negative association = Protective factor
If OR=1 → No association
Calculate OR

Comparing 100 people with hepatic cirrhosis with 150

people with no such a disease. From the diseased group
30 persons are regular alcohol drinkers and from the
healthy group 25 persons are regular alcohol drinkers.

 Q1: Create a 2 x 2 table and interpret the data

 Q2: According to the study what is the odds ratio of
developing hepatic cirrhosis if someone is a regular
drinker?
 Hepatic Hepatic Total
chirrosis chirrosis
+ -
Alcohol + 30 25 55
Alcohol - 70 125 195
Total 100 150 250

OR = 30/70 = 0.42 = 2.1

25/125 0.2
 While the numerical value of the OR differs from the RR
(different formulas are used for the calculation), in case of rare
diseases the OR gives a good estimation of the RR.

Disease Disease Total A/C AxD

+ - OR = = BxC
Risk factor A B A+B
B/D
+
Risk factor C D C+D
-
A/(A+B) A x (C+D)
Total A+C B+D A+B+C+ RR = =
D C/(C+D) C x (A+B)

OR ≈ RR only when „A” and „C” are very small!!

Misinterpretation of OR is common, so care is needed when reading
papers reporting it!
Calculate OR and RR

In country „X” the lung cancer is a rare disease. Imagine

that the incidence of lung cancer is compared between
two cities in this country. One has polluted air (A), the
other has not (B). In the polluted city there were 20 cases
in a population of 100.000; in the other city 10 cases in a
population of 100.000.
You perform the same study in another country (termed
„Y”), where lung cancer is more common. In this
country there were 20 cases in a population of 100 (city
A) and 10 cases in a population of 100 in city B.
Country X:

Lung cancer Lung cancer Total

+ -
Living in city 20 99 980 100 000
„A” (exp)
Living in city 10 99 990 100000
„B” (no exp)
Total 30 199 970 200 000

Country Y:
Lung cancer Lung cancer Total
+ -
Living in city 20 80 100
„A” (exp)
Living in city 10 90 100
„B” (no exp)
Total 30 170 200
 Q1: What is the relative risk of lung cancer in the
polluted city (A) when:
a, Lung cancer is rare (county X)?
b, Lung cancer is common (county Y)?

 Q2: What are the corresponding odds ratios?

Country X 20/100,000 Country Y
RR = =2 20/100
10/100,000 RR = =2
10/100
20/99,980 20/80
OR = = 2.0004 OR = = 2.25
10/99,990 10/90

In case of rare diseases the OR gives a good

estimation of the RR.