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Part IV: Analysis and Interpretation

Student Name

Department, University

Course Number: Course Name

Tutor

Due Date
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Summary of the Study

On 24th February 2009, the Department of Health in Nebraska identified six isolates of

Saintpaul Salmonella. Additional cases were reported in neighboring states. Interviews

were conducted to get to the bottom of the matter. They showed that, out of 14

Nebraska cases, five frequented a certain restaurant and the rest consumed alfalfa

sprouts. In Iowa, out of 7 interviewed patients, one consumed food from a particular

restaurant and the rest took alfalfa sprouts. Most of the patients reported eating alfalfa

sprouts. Investigators aimed to determine whether a particular restaurant or alfalfa

sprouts had anything to do with Saintpaul Salmonella and thus carried out a case-

control study. In the case-control investigation, the alfalfa sprouts odds ratio was 29,

with a 95% confidence interval = 7.5 – 545.2.

Understanding the Odds Ratio

An odd of an event happening is the likelihood that the event will occur. It is expressed as

the proportion of the chances that the event will not happen. In case-control studies, the odds

ratio (OR) is the metric of association (OR can also be used in cross-sectional and cohort study

designs). It measures the association between the exposure to the disease (such as attending an

event or eating a certain food) and the outcome (contracting the disease). It represents the odds

of an outcome occurring given a certain exposure, relative to the odds of the outcome occurring

in absentia of the exposure. OR can be used to determine whether a certain exposure is a risk

factor for certain outcomes or to compare the outcome’s various risk factors (Szumilas, 2010). It
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is computed by dividing the number of case patients who were or were not exposed to the risk

factor by the number of controls who were or were not exposed.

A reference point of +1 is used to analyze OR. An OR of 1 or close indicates that there is

no association between the outcome and the exposure. In other words, its means that the odds of

exposure among case patients are similar to or same as the odds of exposure among the control

group. If it is less than +1, the odds of an outcome occurring are decreased and are below the

odds of exposure among controls. Therefore, being exposed to the factor might have a protective

impact against the outbreak. If it is greater than +1, the odds of the outcome are greater than the

odds of exposure among controls and the exposure might be a contributing factor to the disease

(Smith, 2018). The strength of the association is determined by the OR magnitude. The further

away the OR is from +1, the higher the likelihood of a causal relationship between the outcome

and the exposure.

The odds ratio is usually reported alongside the 95% confidence interval. The 95% CI

estimates the precision of the OR. A wide CI is an indication of a low level of the OR’s

precision. On the other hand, a small CI means that the OR has higher precision. However, it is

important to note that, unlike the p-value, the 95% confidence interval does not measure

statistical significance. Practically, it is normally used as an agent of statistical significance if OR

= 1. Nonetheless, it would not be appropriate to expound the odds ratio with 95% CI that covers

the null value as showing proof of a lack of association between the outcome and the exposure

(Szumilas, 2010).
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Statistical Significance of the Odds Ratio

In the case-control investigation, the alfalfa sprouts OR was 29, with a 95%

confidence interval = 7.5 – 545.2. Remember, the further away the OR is from +1, the

higher the likelihood of a causal relationship between the outcome and the exposure. The OR of

29 indicates a significant association between the consumption of alfalfa sprouts and the

outbreak and the association is strong (because the OR is far away from 1 and the magnitude is

high) and significant. This value can be interpreted as: the patients with the disease were 29

times more likely to have consumed alfalfa sprouts than those without the disease. In other

words, the odds ratio of having consumed alfalfa sprouts was 29 times high among case patients

compared to controls.

The Relationship between Exposure and the Disease

There is a significant association between the consumption of alfalfa sprouts and the

outbreak. First, because the OR is greater than 1, and second because the odds ratio of having

consumed alfalfa sprouts was 29 times high among case patients compared to controls. This

significant association translates to a cause-effect relationship. According to Chen et al. (2010),

when the OR is greater than 6.71, there is a cause-effect relationship. Fedak et al. (2015) say that

a causal relationship is determined by the strength of the association. In epidemiology, an OR of

magnitude 29 is considered high and may trigger a cause-effect relationship. The greater the OR,

the greater the chances that there is a causal relationship between the exposure and the outcome.

A cause-effect relationship can also be proven by the dose-response effect. If there is a

corresponding increase in the outbreak’s prevalence with an increase in the level of exposure to

the risk (that is, dose-response association), the odds of a causal association are strengthened. In
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this case, the increase in consumption of alfalfa sprouts in certain restaurants increased the

exposure.

For there to be a causal relationship, the association must be consistent. If similar

associations are found in different settings, different populations, and different designs of study,

the association is consistent and there is a greater possibility of a causal relationship. After the

first cause-effect association was found by the Nebraska Health and Human Services

Department, similar findings were reached by South Dakota, Missouri, Minnesota, Kansas, and

Iowa Health Departments. This strengthens the cause-effect relationship because the study was

conducted in different states. Furthermore, the subjects did not show the symptoms of the

outbreak before consuming alfalfa sprouts.

After the first cause- effect association was found by the Nebraska Health and Human Services Department, similar findings were reached by South Dakota, Missouri, Minnesota, Kansas, and Iowa Health Departments. This strengthens the cause- effect relationship because the study was conducted in different states. Furthermore, the subjects did not show the symptoms of the outbreak before consuming alfalfa sprouts.
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References

Chen, H., Cohen, P., & Chen, S. (2010). How Big is a Big Odds Ratio? Interpreting the

Magnitudes of Odds Ratios in Epidemiological Studies. Communications in Statistics -

Simulation and Computation, 39(4), 860–864.

https://doi.org/10.1080/03610911003650383

Fedak, K. M., Bernal, A., Capshaw, Z. A., & Gross, S. (2015). Applying the Bradford Hill

Criteria in the 21st century: How Data Integration Has Changed Causal Inference in

Molecular Epidemiology. Emerging Themes in Epidemiology, 12(1).

https://doi.org/10.1186/s12982-015-0037-4

Smith, C. (2018, December 8). Idiot’s Guide to Odds Ratios. Journal Feed.

https://journalfeed.org/article-a-day/2018/idiots-guide-to-odds-ratios/

Szumilas, M. (2010). Explaining odds ratios. Journal of the Canadian Academy of Child and

Adolescent Psychiatry = Journal de l’Academie Canadienne de Psychiatrie de l’Enfant

et de L’adolescent, 19(3), 227–229.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938757/