Name: ______________________ Section and GSI: ______________________

Week 7 Homework: Measures of Risk and Association I & II

Learning Objectives:
 Understand hypothesis testing and be able to identify the null and alternative hypotheses
of epidemiologic studies
 Understand how to interpret a confidence interval and p-value
 Become familiar with different types of variables
 Interpret statistical results from epidemiologic studies
 Understand the concept of risk and learn how to calculate and interpret the different
measures of risk
 Calculate the matched-pairs odds ratio vs. unmatched odds ratio
 Calculate and interpret attributable risk and population attributable risk

Reading:
 Required: Gordis Ch. 11 – 13
 Review lecture slides on risk and statistics

Statistics Resources:
 Merill Chapters (see bCourses)

Problem 1: Statistical Terminology

A. What is statistical inference? How does this process differ from descriptive statistics (e.g.
mean, median, mode)?

B. Define statistical power.

C. If I want to increase the power of my study, should I increase or decrease my sample size?

D. A study produces the following results: OR = 1.45, (95% confidence interval: 0.88, 2.04).
What can we say about the p-value? Do we have evidence to reject the null hypothesis?

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E. Why do some epidemiologists prefer confidence intervals in lieu of p-values?

Problem 2: Hypothesis Testing

Abstract adapted from Ferreccio et. al. (2000) Lung Cancer and Arsenic Concentrations in
Drinking Water in Chile. Epidemiology 11(6): 673-679.

Abstract: Cities in northern Chile had high arsenic concentrations in drinking water in the
period between 1958-1970. We investigated the relationship between lung cancer and arsenic in
drinking water in northern Chile in a case-control study involving patients diagnosed with lung
cancer between 1994 and 1996 and frequency-matched hospital controls. The study identified
152 lung cancer cases and 419 controls. Participants were interviewed regarding their drinking
water sources, cigarette smoking, and other covariates. Logistic regression analysis was used to
calculate exposure odds ratios and 95% confidence intervals (CI). Comparing arsenic
concentrations less than 200 μg/liter or ≥200 μg/liter, investigators obtained an OR = 8.9 (95%
CI = 4.0-19.6, p-value = 0.001).

A. What was the exposure in this study? What was the outcome?

B. State the null hypothesis.

C. State the alternative hypothesis.

D. Define the 95% CI in the context of this study.

E. Interpret the p-value. Do you reject or fail to reject the null hypothesis?

F. Using this study design, how could the researcher have reduced the range of the confidence
interval?

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Problem 3: Statistical Tests
Researchers are working on a study to examine the association between prenatal exposure to lead
and children’s IQ at 5 years of age in a prospective cohort study in Poland. Researchers
measured lead levels in maternal blood samples collected during pregnancy to estimate prenatal
lead exposure. Children were administered a test to measure IQ at age 5. The principal
investigator of the study is having trouble identifying the appropriate statistical test for a given
research question and needs your help! For each question, select the appropriate test from the
following list: correlation test, t-test, chi-square test, ANOVA, linear regression. Note: Each will
only be used once!

A. Are the proportions of children D. How closely are lead levels in

exposed prenatally to low versus maternal blood samples related to the
high concentrations of lead the same child’s IQ?
for boys and girls?

B. How much does a child’s IQ E. Are mean IQ results statistically

decrease with each 10-fold increase different between low-income,
in maternal lead levels, holding age, middle-income, and high-income
gender, and education as constant? children?

C. Is the average maternal blood level

the same in children of Asian and
African-American descent?

Problem 4: Relative Risk (RR) and Risk Difference (RD)

The following data are from a retrospective cohort study on cocaine use during pregnancy and
perinatal outcomes (data adapted from Handler et al. Cocaine use during pregnancy: perinatal
outcomes. Am J Epidemiol 1991;133:818-25).

Table 1. Low birth weight and cocaine use

Cocaine use Low birth weight Normal birth weight Total

Users 147 289

Nonusers 1073 15499
17008

A. What incidence measure can you calculate from these data?

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B. What is the incidence of low birth weight among cocaine users?

C. What is the incidence of low birth weight among non-users?

D. What is the relative risk of low birth weight for cocaine users vs. non-user

E. Interpret the relative risk you calculated in part D.

F. What is the risk difference of low birth weight comparing cocaine users and non-users

G. Interpret the risk difference you calculated in part F.

H. If these data had come from a case-control study, an odds ratio might have been calculated
instead of the relative risk. Please calculate and interpret the odds ratio. Is this an exposure
odds ratio or a disease odds ratio? Please justify your choice in the context of a case-control
study.

I. Compare the OR with the RR.

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Problem 5: Odds Ratio (OR) in a Matched-Pairs Case-Control Study

Hypothetical data from a matched-pairs case-control study to assess the relationship between
sudden unexpected death and smoking history are presented below:

Controls
Cases Smoking ≥1 pack/day Smoking <1 pack/day Total
Smoking ≥1 pack/day 2 36 38
Smoking <1 pack/day 8 34 42
Total 10 70 80

A. Calculate the matched-pairs odds ratio for these data.

B. Using data from the table, un-match the pairs and calculate an unmatched odds ratio. Note
that breaking the match will yield a biased OR! Don’t do this as an epidemiologist in your
career! (The point of this is an exercise to demonstrate that you would get a biased result.)

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Problem 6: Attributable Risk Proportion (AR%) and Population Attributable Risk Proportion
(PAR%)

A. Using the table from Problem 4, calculate the attributable risk percent (AR%) (etiologic
fraction in the exposed or attributable proportion among the exposed) of low birth weight
from cocaine use among the users. Try both formulas and compare the results.

AR% = (incidence in the exposed – incidence in the unexposed) *100

incidence in the exposed

Alternative formula for AR% = (RR – 1)/RR * 100

B. Interpret this AR%.

C. In the state of California, 1% of the female population uses cocaine. What is the population
attributable risk (PAR) (attributable proportion in the total population) for low birth weight
due to cocaine use in California? Also give the population attributable risk proportion (PAR
%). Assume that the hypothetical study data are externally valid.

PAR = (incidence in the total population) – (incidence in the unexposed)

PAR%= [(incidence in the total population) – (incidence in the unexposed)] * 100

(Incidence in the total population)

Alternative formula for PAR% = [Pe (RR–1) / (Pe (RR–1) + 1)] * 100
Pe = Proportion of the population exposed
RR = Risk Ratio or Relative Risk
With the data given, you can also compute the PAR% with these formulas.

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D. Interpret the PAR and PAR% you calculated.

E. What would the PAR% be if 5% of women in California used cocaine?

Problem 7: Attributable Risk (AR) and Attributable Risk Percent (AR%)

The results of a hypothetical 10-year cohort study to assess the relationship between smoking
and coronary heart disease (CHD) are shown below:

CHD after 10 years (n) No CHD after 10 years (n)

Healthy smokers 69 1925
Healthy nonsmokers 17 3977

A. Calculate the incidence of CHD in smokers that could be attributed to smoking.

B. Calculate the proportion of the total incidence of CHD in smokers that was attributable to
smoking.

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Problem 8: Population Attributable Risk (PAR) and Population Attributable Risk Percent (PAR%)

In a cohort study of smoking and lung cancer, the incidence of lung cancer among smokers was
found to be 12/1000 and the incidence among nonsmokers was 3/1000. From another source we
know that 35% of the total population were smokers at the time.

A. Calculate the incidence of lung cancer attributable to smoking in the total population (PAR).

B. Calculate the proportion of the risk in the total population that was attributable to smoking (PAR
%).

Problem 9: Interpreting Measures of Effect:

Interpret the following measures of effect.

A. Exposed: Drivers driving with blood alcohol content (BAC) > 0.8%
Unexposed: Drivers driving with BAC < 0.8%
Outcome: Vehicle collision
Attributable (Excess) Risk: 25/1000

B. Exposed: People who do not sleep underneath mosquito netting in a refugee camp
Unexposed: People who sleep under mosquito netting in a refugee camp.
Outcome: Malaria
Risk Ratio: 2.0
Population sleeping under a mosquito net: 50%
Population Attributable Risk Percent: 33%

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Problem 10: Relative Risk (RR) and Attributable Risk (AR)

A. A single exposure has a relative risk for disease A of 10.0 and for disease B of 1.5. Why
might the attributable risk (AR) and the population attributable risk (PAR) of the exposure
for disease A be lower than that of disease B?

B. Exposure A has a relative risk for a disease of 10.0 and exposure B has a relative risk for the
same disease of 1.5. Why might the population attributable risk (PAR) and the population
attributable risk percent (PAR%) of the disease for exposure A be lower than that of exposure
B?