A n I n t r o d u c t i o n t o the Use of E p i d e m i o l o g i c Research
M e t h o d s in D a i r y Science
ABSTRACT
Many dairy scientists are not familiar
with epidemiologic study designs and
measures. The various designs (cross-
sectional, case-control, cohort) are re-
viewed with special reference to their
strengths and weaknesses. Epidemiologic
measures (incidence and prevalence rates,
relative risk, odds ratio, attributable
fraction, and population attributable
fraction) are defined, and their validity in
the contexts of the different study
designs is discussed.
Incidence rate (risk of disease) is the
number of new cases of a disease divided
by the population at risk during a specified
time period. Prevalence rate is the fre-
quency of both new and old cases in a
population at a specified point or period
in time divided by the average population
during that same period. Both incidence
and duration of disease contribute to
prevalence. Odds ratios and relative risks
are measures of association (how much
disease the exposed group experienced
relative to the nonexposed group) and are
used to assess the relative hmportance of
risk factors. Attributable fraction is the
proportion of the incidence in the exposed
group that can be attributed to the
specific exposure. Population attri-
butuable fraction is the expected reduc-
tion in incidence in the whole population
Received November 4, 1985.
Accepted September 11, 1986.
t Supported in part by a National Science Founda-
tion Graduate Fellowship. Present address: Department
of Clinical Sciences, College of Veterinary Medicine
and Biomedical Sciences, Colorado State University,
Fort Collins 80523.
2 Reprint requests.
1987 J Dairy Sci 70:373-380
CHARLES R. CURTIS, 1 HOLLIS N. ERB, 2
and JANET M. SCARLETT KRANZ
Section of Epidemiotogy
Department of Clinical Sciences
New York State College of Veterinary Medicine
CornelI University
Ithaca, NY 14853
if the specific exposure were prevented.
The attributable fractions are useful in
planning preventive and herd health
programs.
INTRODUCTION
Epidemiologic study designs are being used
more and more often in animal disease research.
Such studies can be used to evaluate the impact
of management on health and performance and,
ultimately, to formulate herd health and
preventive or control programs. However, a
working knowledge of epidemiologic designs
and measures is required, particularly their
strengths and weaknesses in various situations.
Analytic designs (cohort, case-control, cross-
sectional) are observational and are often
conducted in the "field"; therefore, the designs
are used to establish "association", not "causa-
tion". Certain measures (e.g., incidence rate)
can be calculated only from specific designs,
whereas other measures (e.g., odds ratio) can be
derived from all three designs.
The objective of this paper is to review the
basic analytic epidemiologic study designs and
measures with emphasis on their strengths,
weaknesses, and the validity of conclusions that
can be derived from them for use in evaluating
relationships between risk factors and disease
and in formulating herd heath, preventive or
control programs for dairy cattle. The secondary
objective is to discuss the nature of "disease",
because it is pertinent to what the designs can
accomplish.
DISEASE AND EXPOSURE
The criteria used to define disease can vary
widely, and any particular study should detail
carefully the criteria used. The definition of
disease can range from a broad clinical sign
(e.g., diarrhea) to a specific genetic defect or
aberration. Disease can be thought of as a
373
374 CURTIS ET AL.
model in which the presence or absence of signs
predicts whether the disease is present or absent
(1).
One important consideration is the differen-
tiation between clinical and subclinical disease.
In subclinical disease, pathogenic changes occur
but there are no overtly detectable clinical signs
(14). Clinical disease is defined by overtly
observable signs associated with underlying
pathogenic changes (14). Subclinical disease
does not always progress to clinical disease. For
example, for every clinical case of mastitis in a
herd there are 10 subclinically affected animals
(12). Clinical and subclinical disease states have
generally similar etiologies except that some
factor distinguishes the clinically from the
subclinically affected animal, which explains
the difference in disease expression. If both
clinical and subclinical diseases are grouped
together, factors that influence the development
of clinical manifestations may be missed or
confused with factors associated with the
etiology of the subclinical disease. If the disease
has both clinical and subclinical manifestations,
it should be examined using separate clinical
and subclinical classifications to differentiate
between factors associated with the etiology of
the underlying pathogenesis and factors asso-
ciated with development of clinical manifesta-
tions (9, 15). Problems also can result when
clinical disease syndromes have several etiologies;
for instance, "secondary" ketosis has a different
etiology than "spontaneous" ketosis, although
the clinical manifestations are similar (10).
An alternative approach to using subclinical
and clinical classifications is a classification
scheme based on severity or stages of progression
of diseases (e.g., in human cancer). Although
this approach can be useful, there are dis-
advantages. It can be hard to standardize
nomenclature and definitions for severity or
stages. Of practical importance is the relative
lack of availability (and understanding) of
multivariate techniques for polychotomous
outcomes (9).
Duration of disease has received more
attention than severity of disease, especially for
mastiffs (12). Duration is important from both
economical and health (primarily prognosis)
reasons. For example, the longer the duration
of mastiffs, the lower the milk yield, the higher
the cost for treatment, the greater the damage
to udder tissue, and the greater the opportunity
Journal of Dairy Science Vol. 70, No. 2, 1987
for transmission to other cows. The inclusion of
prevalent cases (i.e., those that have existed
for some time before a study is initiated) can
result in confusion of prognostic with etiologic
factors. One major disadvantage of examining
duration of disease, and perhaps the major
reason it is not widely studied, is that it is
often very difficult to measure in an uncon-
trolled (i.e., the field) situation. For example,
for diseases such as mastiffs and scours, quanti-
fication is difficult, because the clinical signs
may become inapparent for some time and then
reappear, making it difficult to establish whether
the reappearance of the signs signals a new
occurrence of disease or merely a flare-up of
the old disease. Because of this problem, some
investigators have chosen to evaluate only the
first occurrence of a disease in a lactation (2, 3,
5,6,8).
"Exposure" refers to risk (or protective)
factors; these factors can be variable (e.g.,
another disease, a chemical, a drug, a vaccine).
In observational studies, exposures are only
measured rather than dictated (the reverse is
true of experimental studies). One of the
greatest difficulties is measuring exposure
accurately, especially since it often is assessed
retrospectively. The strengths and limitations of
the methods used to assess exposure (e.g.,
laboratory tests, questionnaires, observations)
must be considered carefully, as the methods
determine the quality of data and affect the
ability of the researcher to infer a causal
relationship. An example from our own studies
(2) was our use of nutritional data collected
from a questionnaire rather than from actually
measuring feed intake/orts and analyzing
nutrient content of feed. We were careful to
point out the nature of these data and not to
make "strong" causal inferences regarding the
relationships observed.
EPIDEMIOLOGIC STUDY DESIGNS
The three basic study designs of analytic
epidemiology are cohort, cross-sectional, and
case-control (9, 13, 14). The basis for their
difference is related to the method of sampling
employed.
In a cohort design, subjects (e.g., farms,
cows, feedlot pens) are selected based on
presence or absence of exposure. The exposed
(E+) and unexposed (E--) subgroups (cohorts)
 OUR INDUSTRY TODAY
are examined for development of disease
subsequent to exposure (9, 14). Data may or
may not be retrospective, depending on whether
exposures and disease already have taken place.
The cohort design is very similar to a clinical or
field trial except that 1) in a trial the exposure
is created (applied) and assigned by the inves-
tigator and 2) the trial cannot be retrospective.
For example, the herds that receive herd health
care from the New York State College of
Veterinary Medicine could be classified (Figure
1) based on housing type: freestalls (E+) and
tiestalls (E--). If these herds are monitored for
1 yr and the incidence of clinical mastiffs (D+)
compared between the two housing types, this
would be a prospective cohort study looking at
the association of housing t y p e to the occur-
rence of mastitis. If, instead, the records from
1980 were used to classify the herds on the
basis of housing, and the incidence of mastitis
was assessed from the records for 1981, the
study design would be a retrospective cohort,
because the events occurred before the study
was initiated. Another example of retrospective
cohort design is in the study in Michigan (7)
after polybrominated biphenyls (PBB) inad-
vertently were added to cattle feed. The exposed
group was composed of farms that fed the PBB
contaminated feed. Cohort studies are useful
when the disease under study is common, the
exposed and unexposed groups are easily
identified, and follow-up is relatively easy (9).
For a rare disease, the cohort design is im-
practical, because large cohorts are needed to
accumulate enough cases to have sufficient
power to detect differences in disease risk (9,
13).
In cross-sectional studies, animals are sampled
without regard for disease or exposure status
and subsequently classified in disease-exposure
categories (Figure 1). Exposure and disease are
assessed concurrently (9, 14). These studies also
are called prevalence studies, because the cases
of disease exist (are prevalent) when the study
is conducted (rather than being accumulated as
they occur). For example, Curtis et al. (3)
cross-classified all cows calving on 33 dairy
farms on the basis of parturient hypocalcemia
(disease) and eight other periparturient diseases
(exposures). The time order of the various
diseases was not assessed; therefore, the study
had a cross-sectional design. In general, the
assumption cannot be made in a cross-sectional
375
study that the exposure preceded disease;
therefore, one should be careful about cross-
sectional studies that make "causal" claims.
In the case-control design, cases of the
disease (D+) are accumulated and controls (D--)
are obtained randomly, usually from the same
population (4, 9, 13, 14). In the case-control
study the distribution of D+ and D-- animals
is usually not in proportion to the " t r u e "
proportional distribution of cases and controls
in the population (4, 9, 13, 14). In contrast, the
cohort study (being a random sample or total
population of exposed and unexposed animals)
represents the true proportions of D+ and D--;
this becomes extremely important in the risk
and association sections. Exposure (occurring
before the disease developed among the cases
and during a comparable period in the controls)
is assessed for the two groups (13). Case-control
studies can be prospective but usually are
retrospective. The case-control study is statis-
tically efficient for studying rare diseases (13).
Other advantages of the case-control design are
the relatively rapid conduct, smaller sample
sizes required, lower expense, and no need for a
follow-up period as with the prospective cohort
design. The major disadvantages of the case-
control study are that incidence rates cannot be
measured and there is a relatively large potential
for bias inherent to the design (13). The poten-
tial biases, which are beyond the scope of this
discussion, relate to how cases and controls
were selected as well as to problems in assessing
exposure retrospectively when disease status is
known (4). An example of a case-control study
is the one Grymer et al. (8) conducted of left
= ~s~s~ ~ =n~ ~s~s~
cases = control S
a b
E-+ = exposed liE+= a+b
E- ~ non-exl~osed c d NE_= c+d
ND,= a~: ND.=b*d N*
Figure 1. Distribution of exposure and disease in
a2 × 2table.
Journal of Dairy Science Vol. 70, No. 2, 1987
376 CURTIS ET AL.

abomasal displacement ( L D A ) in Denmark. IR (Table 1) can be calculated o n l y in the

T h e y selected 22 herds a f f e c t e d with L D A
(cases) and 12 u n a f f e c t e d (control) herds. F e e d
composition was e x a m i n e d as a risk factor for
LDA, and < 1 7 % crude fiber fed in the ration
(E+) increased risk of L D A 10-fold c o m p a r e d
with feeding > 17% crude fiber (E--).
MEASURES OF RISK
Risk is measured (assessed) primarily using
incidence rates [IR (9, 13, 14)]. An IR is the
n u m b e r of new cases of disease divided by the
p o p u l a t i o n at risk during a specified interval (9,
13, 14). Thus, an IR estimates the probability
that an individual in the p o p u l a t i o n at risk
will develop the disease during an interval.
Erb et al. (5) introduced the t e r m "lactational
incidence r a t e " (LIR) in which the n u m b e r of
lactations at risk is the d e n o m i n a t o r of the IR.
This is a useful c o n c e p t for the dairy scientist,
because the unit of observation is a lactation
rather than an individual cow for a variable
n u m b e r of physiological cycles. A valid overall
following designs: 1) a c o h o r t study where
the exposed and u n e x p o s e d cohorts are in pro-
p o r t i o n to their true values in the p o p u l a t i o n
(i.e., by r a n d o m sampling) or in a c o h o r t study
where a defined p o p u l a t i o n is entirely e x a m i n e d ,
or 2) the special circumstance of a case-control
study in which the entire target p o p u l a t i o n is
being examined. F o r example, f r o m Figure 2
and Table 2, the overall IR of retained placenta
= 1 5 6 / 1 3 7 4 = .114, = 11.4%, or 11.4 cases per
100 cows at risk (Table I formulas). Exposure-
specific IR refers to the IR in the E+ and E--
groups and these are i m p o r t a n t for calculation
o f certain measures of association (Table 1).
Neither overall nor exposure-specific IR can be
calculated validly f r o m a cross-sectional study
(9) or (usually) f r o m a case-control study
[except in the rare case in which the entire
target p o p u l a t i o n has been used and f o l l o w e d
(9, 13, 1 4 ) ] ;
The prevalence rate (PR) is not a true
measure of risk; rather, PR means the f r e q u e n c y

TABLE 1. Formulas for calculation of epidemiologic measures. 1

Measure Formula

Overall incidence rate (IR) ND+ = a+c

N* a+b+c+d
IR in the E+ = 1RE+ a
=
a

NE+ a+b
IR in the E - = IR E _ C = C

N E_ c+d
Overall Prevalence Rate (PR) ND+ = a+c
N* a+b+c+d
Relative Risk (RR) IRE+ = a/NE+ = a/(a+b)
IRE- c/N E_ C/(c+d)
Odds Ratio (OR) a/b m ad
c/d bc
Attributable Fraction (AF) IRE+ - IRE-- = R R - 1
IRE+ RR
Population Attributable Fraction (PAF) 2 P(E+)*(RR-- 1)
1 + p(E+)*(RR-1)

See Table 2 for variables in formulas.

2 P(E+) = proportion exposed in target population.

Journal of Dairy Science Vol. 70, No. 2, 1987

 OUR INDUSTRY TODAY 377

T A B L E 2. Measures of risk and association from a 2 × 2 table of milk fever and retained placenta. ~

S t u d y design
Measure Cohort Case-control Cross-sectional

LIR 2 of retained placenta (RP) 156 = .114 NA 3 NA

1374
LIR of milk fever (MF) 90 = .066 NA NA
1374
LPR 4 of RP 156 = . 1 1 4 NA .114
1374
LPR of MF 90. = .066 NA .066
1374
R R s of RP for cows 2 3 / 9 0 = 2.47 NA NA
with MF 133/1284
OR 6 for RP for cows 23 × 1151 = 2.97 2.97 2.97
with MF 67 × 133
AF T of RP a m o n g cows 2.47-1 = .6 NA NA
with MF 2.47

PAF s of RP a m o n g 9 0 / 1 3 7 4 ( 2 . 4 7 - 1 ) = .09 NA9 NA9

cows with MF 1+90/1374 (2.47-1)

1 Data from Curtis et al. (2) and presented in Figure 2; n = 1374 m u l t i p a r o u s Holstein cows; 33 herds, Ithaca,
NY, See Table 1 for formulas of different measures.
2 LIR = Lactational incidence rate.
3 NA = Not applicable.
4 LPR = Lactational prevalence rate,
s R R = Relative risk.
6 OR = Odds ratio.
7 A F = Attributable fraction.
s PAF = Population attributable fraction.
9 Can be calculated if O R and proportion o f exposed controls are known.

of disease (both new and continuing cases) at a i s t i n g c a s e s it will b e i n f l u e n c e d b y t h e d u r a -

s p e c i f i c p o i n t o r p e r i o d in t i m e (9, 1 3 , 14). The t i o n o f d i s e a s e : P R = I R × d u r a t i o n (9, 1 4 ) .
PR includes survivors of the disease, and N a t z k e ( 1 2 ) i l l u s t r a t e d t h i s r e l a t i o n s h i p in
t h u s , it is n o t v e r y u s e f u l in l o o k i n g f o r risk the context of mastitis control programs with
f a c t o r s if t h e d i s e a s e is r a p i d l y f a t a l . P r e v a l e n c e a n e q u a t i o n ( a v e r a g e level o f i n f e c t i o n = t o t a l
rates are useful when planning or evaluating Cow had place~xta retained
>24 hr
s o m e p r e v e n t i v e o r c o n t r o l p r o g r a m s , e.g., t o
consider costs or to evaluate a decline due to
yes (D+) no (D-)
a successful control or prevention measure.
Incidence rates also can be used to evaluate the yes (E+) 23 67 90
e f f e c t i v e n e s s o f p r e v e n t i v e p r o g r a m s , b u t as
Cow had cli.n.ical
discussed previously, these rates are more milk f e v e r no (E-) 133 1151 1284
d i f f i c u l t t o o b t a i n . P r e v a l e n c e r a t e s ( T a b l e 2)
can be calculated from cohort and cross- 156 1218 1374
sectional but usually not from case-control Figure 2. A 2 × 2 table of milk fever and retained
s t u d i e s (9, 1 4 ) . B e c a u s e t h e P R i n c l u d e s e x - placenta.

Journal o f Dairy Science Vol. 70, No. 2, 1987

378 CURTIS ET AL.

cows infected × duration of infection) and
concluded that prevalence of infection could be
reduced by decreasing the rate of new infections
or by decreasing the duration of infection.
Only for diseases of short duration (relative
to the period of observation) will PR approx-
imately equal IR (9, 14). To illustrate the
difficulty in using the lacational prevalence rate
(LPR) to estimate LIR we examined LPR for
milk fever and retained placenta for different
observation periods (Table 3). Milk fever is a
disease of short duration (usually 1 d) and
retained placenta is of longer duration [median
3 d (2)]. Prevalence rates were calculated
(Table 3) for six, 7-d periods and two, 30-d
periods chosen at random from data reported
elsewhere (2). The PR includes all existing cases
on the starting day of the specified period and
those new cases occurring during the period.
The denominator is the number of cows in milk
plus the new lactations begun during the
period. The LPR for both milk fever and
retained placenta differ substantially from the
LIR in Table 2. Even for the longer 30-d
periods (long relative to the duration of disease),
the LPR both overestimate and underestimate
the LIR for both diseases.
MEASURES OF ASSOCIATION
The measures of association with which
epidemiologists are most concerned are relative
risk (RR; or risk ratio), odds ratio (OR; or
relative odds ratio), and attributable fraction
(AF). Relative risk and OR essentially estimate
the same thing: the risk of disease given presence
of exposure relative to the risk of disease given
the absence of the exposure (9, 13, 14, 17).
Relative risk is actually a "relative incidence
rate ratio", and the OR is actually a "ratio
of relative odds of disease" in exposed and
unexposed subjects (alternatively, because OR
is bidirectional, "ratio of relative odds of
exposure" in diseased and nondiseased subjects).
Relative risk can be calculated (Table 1) validly
only in the same situations as for exposure-
specific IR [IRE+, IR E_ (9, 14, 16)].
One formula for the OR equals the ratio of
the "odds of D+ given E+" to the "odds of D+
given E--". The OR can be calculated (Table 1)
from any of the designs because it does not
depend on IR. In addition, the OR is an es-
timator of the RR (9, 14, 17) for all study
designs when the disease is rare (e.g., overall IR
<.05). We will restrict our discussion to OR,
although much of what is stated also applies to
RR.
Odds ratios are a multiplicative measure of
risk that range in value from 0 to positive
infinity (13, 14, 17). The null value (no associa-
tion) is 1 (13, 17). Odds ratios >1 imply a
direct association between the factor and
disease [i.e., the factor puts the animal at
increased risk of disease (13, 17)]. Odds ratio
<1 imply an inverse association [i.e., the factor
decreases risk of disease (11, 17)]. Odds ratios

TABLE 3. Lactational prevalence rates of retained placenta and milk fever for different observation periods.l

Period Prevalence/100 lactations

Starting Retained Milk
date 2 Length placenta fever

(d)
5/30/81 30 20.5 9.4
12/26/81 30 8.0 3.3
3/08/81 7 7.1 3.6
8/02/81 7 20.0 0
10/04/81 7 3.2 3.2
10/25/81 7 11.0 8.3
11/01/81 7 8.0 2.0
11/15/81 7 9.7 12.9

1Data from Curtis et al. (2); n = 1374 Holstein cows; 33 herds; Ithaca, NY.
2Starting dates of periods picked at random between February 1981 and March 1982.

Journal of Dairy Science Vol. 70, No. 2, 1987

 OUR INDUSTRY TODAY
of 2 and .5 (1:2) have the same correlative
magnitude but imply associations in opposite
directions. Odds ratios are biased further away
from the null value of 1 than the RR when the
disease is common, although as the probability
of disease decreases and the sample size in-
creases, OR and RR are approximately equal
(asymptotic) to each other (9). Significance
tests of the null hypothesis OR = RR = 1.0 and
confidence intervals can be calculated for the
OR and RR (9, 13).
F r o m Figure 2 and Table 2, if milk fever is
the exposure of interest and its association with
retained placenta is to be assessed, the following
would be true: If this were a cohort study, we
could calculate an overall IR, IRE+ , IRE_ , PR,
RR, and OR. The OR = 2.97 means that a cow
with milk fever is 2.97 times more likely to
develop retained placenta than a cow without
milk fever. Only the OR could be calculated if
the case-control design were assumed; for a
cross-sectional study, only the PR and OR
could be calculated. Also, for the cohort study,
OR > RR (since RR > 1). As an example of an
OR < 1, Erb et al. (6) found that primiparous
heifers that conceived at first service had OR =
.1 of subsequently being culled. This OR means
that heifers conceiving at first service were 10
times less likely to be culled than heifers that
did not conceive at first service.
Strength of association (RR or OR very
different from 1.0) is helpful in inferring
causation, although it does not stand by itself
and should be used in conjunction with other
evidence (11, 15). There are no formal guide-
lines for what magnitude of association strongly
suggests a causal association, although there
should, of course, be statistical significance.
There is a rough guideline that states that " R R
of magnitide greater than 5 are likely to be
causal" (11). This is because in a well-designed
study, it is unlikely that an unsuspected source
of bias exists that is sufficient to create such
disparity in the observed data.
Attributable fraction is used most often for
application in public health (or herd health)
and preventive medicine. Attributable fraction
is the proportion of the incidence rate in the
exposed group that can be attributed to the
exposure factor, and A F usually can be calcu-
lated (Table 1) only when IRE+ and IR E _ are
valid (9, 13, 16). Attributable fraction assumes
a causal relationship and indicates the relative
379
importance of the exposure in the exposed with
respect to the disease studied. The A F for milk
fever from Table 2 is .6. The interpretation of
this A F is that 60% of the IR of retained
placenta in cows with milk fever can be attri-
buted to milk fever.
In order to estimate (using the A F ) how
much disease could be prevented in the target
population, the amount of exposure must be
considered. If, instead, only 1% of the target
population were exposed (i.e., had milk fever),
then 1% of the IR of retained placenta could be
prevented in the target population if milk fever
were prevented. If the prevalence of milk fever
was 20%, then 23% of the IR of retained
placenta could be prevented by preventing milk
fever. This estimate is called the population
attributable fraction (PAF) or etiologic fraction
[(13, 16, 17)see Table 1 for formula].
Attributable fraction and PAF are very
useful to formulate herd health and prevention
measures. With the advent of multivariate
statistical techniques, A F and PAF estimates
can be obtained while adjusting for other
confounding factors and multivariate inter-
actions. Using the example illustrated, a pre-
vention program for milk fever to reduce
the incidence of retained palcenta in a herd
with IR of milk fever equal to 1% would have
little merit. However, in a herd with IR of milk
fever equal to 20%, a program of milk fever
prevention would be useful to prevent both
disorders.
G E N E R A L DISCUSSION
When little is known about a disease or
condition, a cross-sectional study is usually the
first approach taken by an epidemiologist. The
cross-sectional design usually is less costly than
the other designs and can provide information
on the prevalence of disease and its possible risk
factors (as determined by OR) for future
studies. If the disease is rare (e.g., bovine
leukemia) one might decide to conduct a
case-control study to determine further etiology
of the disease. It would be difficult and costly
to conduct a cohort study of rare disease, and
one would gain little more knowledge than
from the case-control study. If the disease is
common (>5%), one might prefer to do a
cohort study because of the ability to calculate
IR, AF, and PAF, which have distinct ad-
vantages for implementation of herd health and
Journal of Dairy Science Vol. 70, No. 2, 1987
380 CURTIS ET AL.
preventive control programs. Unfortunately,
c o h o r t studies are costly a n d t i m e - c o n s u m i n g .
A d d i t i o n a l l y , studies t h a t i n s t i t u t e p r e v e n t i v e
p r o g r a m s (e.g., m a n a g e m e n t changes, disease
c o n t r o l p r o c e d u r e s ) s h o u l d m e a s u r e changes in
disease o c c u r r e n c e a n d c o m p a r e t h e s e m e a s u r e s
to t h o s e e s t i m a t e d w i t h P A F f r o m c o h o r t
studies. A g r e e m e n t b e t w e e n t h e s e d i f f e r e n t
t y p e s of studies s h o u l d b e c o n s i s t e n t , b u t
c o n s i s t e n c y a l o n e is n o t conclusive o f a causal
link.
The different epidemiologic measures may
a p p e a r t o be v a r i a t i o n s of each o t h e r , b u t t h e i r
i n t e r p r e t a t i o n a n d validity can b e very im-
p o r t a n t in t h e c o n t e x t of e v a l u a t i n g a p u b l i s h e d
r e p o r t . If t h e m e a s u r e is i n a p p r o p r i a t e for
t h e design, o n e s h o u l d b e c o n c e r n e d n o t o n l y
about the conclusions drawn but about the
s t u d y as a w h o l e (for e x a m p l e , a cross-sectional
study that reported RR and PAF and made
preventive control recommendations). The
m e a s u r e s have d i s t i n c t uses: I R a n d P R to
describe disease o c c u r r e n c e , O R a n d R R to
describe t h e r e l a t i o n s h i p o f disease t o risk
f a c t o r s a n d possible etiology, a n d A F a n d P A F
t o describe t h e m a g n i t u d e o f a risk f a c t o r s
effect o n t h e o u t c o m e o f interest.
We have discussed o n l y t h e n a t u r e of t h e
designs a n d i n t e r p r e t a t i o n o f measures. A n
i m p o r t a n t c o n s i d e r a t i o n in e p i d e m i o l o g i c studies
is h o w possible c o n f o u n d i n g f a c t o r s a n d biases
have b e e n h a n d l e d in t h e s t u d y (4, 9, 13). With
t h e a d v e n t o f m u l t i v a r i a t e statistical t e c h n i q u e s ,
epidemiologists h a v e b e e n able t o o b t a i n
e s t i m a t e s of R R , OR, A F , a n d P A F w h i c h are
a d j u s t e d for t h e o t h e r risk f a c t o r s a n d con-
f o u n d e r s in t h e m o d e l a n d to assess possible
i n t e r a c t i o n s b e t e e n risk factors. Studies t h a t
e m p l o y e p i d e m i o l o g i c designs, m e a s u r e s , a n d
techniques should enable epidemiologists and
o t h e r s t o m a k e scientifically s o u n d a n d r a t i o n a l
r e c o m m e n d a t i o n s for h e r d h e a l t h a n d p r e v e n t i v e
m e d i c i n e programs.
ACKNOWLEDGMENTS
T h e a u t h o r s t h a n k D. E. B a u m a n , M. D.
Cooper, M. T. Correa, D. S. K r o n f e l d , P.
Dargent, N. Moser, P. A. O l t e n a e u , Y. H.
S c h u k k e n , S. Schwager, R. D. S m i t h , D. Strick-
Journal of Dairy Science Vol. 70, No. 2, 1987
land, a n d M. E. W h i t e for reviewing t h e m a n u -
s c r i p t a n d f o r t h e i r h e l p f u l suggestions.
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