Relative Risk and Odds Ratios

Table of Contents
Relative Risk and Odds Ratios ........................................................................................... 1 What is RELATIVE RISK?............................................................................................ 1 What are ODDS RATIOS?............................................................................................. 1 Calculating Relative Risk ................................................................................................... 1 Calculating Relative Risk ............................................................................................... 1 Relative Risk: A Rule of Thumb .................................................................................... 2 Summary ......................................................................................................................... 2 Calculating Odds Ratios ..................................................................................................... 2 Calculating Odds Ratios ................................................................................................. 2 Important Considerations.................................................................................................... 3 List .................................................................................................................................. 3 Attributable Risk................................................................................................................. 5 What is Attributable Risk?.............................................................................................. 5 Calculating Attributable Risk ......................................................................................... 5 Glossary .............................................................................................................................. 6 References........................................................................................................................... 7

Relative Risk and Odds Ratios

What is RELATIVE RISK? In the population under investigation, relative risk refers to a ratio between members of the population expressing the trait of interest (e.g. cancer), with distinction made between whether or not those members had previously been exposed to a related risk.

What are ODDS RATIOS? Odds ratios refer to a ratio between members within a population expressing a trait or not, relative to their exposure to a related risk (i.e.
has trait(exposed)/has trait(not exposed) x lacks trait (exposed)/lacks trait (not exposed)).

Calculating Relative Risk

Calculating Relative Risk

Relative risk is often calculated for the following types of epidemiological studies: - Cohort studies - Disease register studies - Randomized control trials

The following table will be of use in calculating relative risk:

Rate of incidence for members with risk factor present = a/a+b Rate of incidence for members lacking risk factor = c/c+d Relative risk = rate with risk = rate without risk
1

(a/a+b) (c/c+d)

Relative Risk: A Rule of Thumb Generally, when comparing an experimental group to a control group: - A relative risk of 1 indicates a lack of difference between the two groups in terms of risk. - A relative risk less than 1 indicates the trait has a lesser likelihood of being expressed in the experimental group than in the control group. - A relative risk greater than 1 indicates the trait has a greater likelihood of being expressed in the experimental group than in the control group. Summary In calculations of relative risk, researchers should weigh additional considerations aside from the initial association, making the required modifications. For example, age and sex standardizations may be required, but these are beyond the scope of this tutorial. Having made the needed changes, a researcher can view the relative risk as a reasonable guage of the strength of an association.

Calculating Odds Ratios

Calculating Odds Ratios Refer to the chart above. From this chart, the odds of exposure to a risk factor for the group with a disease is a / c and the odds of exposure to the risk factor for the group without the disease is b / d. Similar to relative risk, the odds ratio for exposure is equal to a/c divided by b/d. Similar to the odds ratio for exposure, the odds ratio for disease is equal to a/b divided by c/d, where a/b represents the odds for disease in those exposed to the risk and c/d represents the odds for disease in those not exposed to the risk factors.

So, we have found the following two formulas: Exposure Odds Ratio: Disease Odds Ratio:

In terms of computation, it is typically simpler to multiply than to divide, leading us to rearrange the odds ratios in finding the crossproduct ratio. Exposure Odds Ratio: Disease Odds Ratio:

Cross-Product Ratio:

Note that the cross-product ratio is exactly the same for exposure and disease!

Important Considerations
List 1) Mistaken Estimations of Relative Risk As was touched on previously, we may run into problems when calculating disease incidence in a population to find relative risk. For instance, numerous experimenters have committed the error of gathering data from large populations and comparing the resulting incidence rates and relative risk to those of small populations. This may cause issues by falsely attributing cases of disease and risks of disease to smaller populations. These and other considerations must be factored in before calculating and interpreting relative risk.

2) Cases Where Relative Risk Lacks Usefulness Incidence data is needed to calculate relative risk, which we know from the definition of relative risk (i.e. it is the ratio of two incidence rates). For instance, relative risk cannot be calculated for case-control studies, as they provide no incidence data. Unfortunately, relative risk can be calculated for some case-control studies, but this is beyond the scope of this module. Relative risk also lacks usefulness in the event that non-occurrence of disease is of equal interest to occurrence of disease. As we have seen previously, the odds ratio gives a symmetrical result, while the relative risk does not.

3) Cases Where the Odds Ratio is Useful - the prevalence rate ratio when the prevalence of exposure is low. Note, prevalence refers to a sum of instances of particular traits within a population at a certain moment in time. - Relative risk in a cohort study where the incidence of disease in the control group is low, generally viewed as those less than 10-20%, which is a common occurrence. - the relative risk in a case-control study where exposure in the control group is equivalent to the population from which the instances are drawn.

4) Take Care in Interpreting the Odds Ratio If there is a significant difference between the levels of exposure and rates of incidence, the odds ratios are not equivalent across time, population, or location. For instance, studies from Timmins will likely differ from studies conducted in Collingwood, due to the fact that the level of exposure in the control group is not equivalent. This holds even when the relative risks are equivalent, as per our previous discussions. Note, epidemiologists often misinterpret the odds ratio, so take care in

accepting the results of studies which report it. Many will incorrectly consider the odds ratio as a fair measure of risk.

Attributable Risk
What is Attributable Risk? Attributable risk refers to the number of instances which would not have been observed had a certain risk factor not been present. In other words, attributable risk refers to the proportion of the incidence of disease in individuals having had risk exposure that can be ascribed to that risk factor.

Calculating Attributable Risk Taking the total number of instances, subtract the number of cases that would have happened regardless of whether the risk factor had been present. The remaining instances represent those that can be accounted for by the risk factor. This value is typically written as a percentage. So, attributable risk is the surplus risk in the exposure group, written as a fraction of total risk.

Glossary Relative Risk (RR):

In the population under investigation, relative risk refers to a ratio between members of the population expressing the trait of interest (e.g. cancer), with distinction made between whether or not those members had previously been exposed to a related risk. Odds ratios refer to a ratio between members within a population expressing a trait or not, relative to their exposure to a related risk. Attributable risk refers to the number of instances which would not have been observed had a certain risk factor not been present. is a measure of the risk of developing some new condition within a specified period of time, often loosely expressed as the number of new instances within a specific time period. prevalence refers to a sum of instances of particular traits within a population at a certain moment in time, which can be expressed as the total number of instances in the population, divided by the total number of individuals in the population.

Odds Ratio (OR):

Attributable Risk (AR):

Incidence:

Prevalence:

References
Bhopal, R. 2002. Concepts of Epidemiology. Oxford: Oxford University Press.