UKURAN ASOSIASI

DALAM EPIDEMIOLOGI
Putri Handayani, M. KKK
 Tipe ukuran yang digunakandalam
epidemiologi
• Ukuran asosiasi
– Merefleksikan kekuatan atau besar asosiasi
antara suatu eksposur/faktor risiko dan kejadian
suatu penyakit

– Memasukkan suatu perbandingan frekuensi

penyakit antara dua atau lebih kelompok dengan
berbagai derajat eksposur

– Beberapa ukuran assosiasi digunakan untuk

mengestimasi efek
Basic Question in Analytic Epidemiology

• Are exposure and disease linked?

e Disease
 Ukuran-ukuran asosiasi
• Ukuran rasio (perbandinganrelatif)
– rasio dua frekuensi penyakit membandingkan
kelompok terpajan dengan kelompok tidak
terpajan
• Ukuran perbedaan efek(perbandingan
absolut)
– perbedaan antara ukuran frekuensi penyakit
suatu kelompok terpajan dan kelompok yang
tidak terpajan
 Two-By-Two Table

Disease
Yes No Total

a b a+b
Yes
Exposure
c d c+d

No Total a+c b+d a+b+c+d

 Hypothetical Two-By-Two Table

Lung cancer
Yes No Total

70 300 370
Yes
Smoking
15 700 715

No
Total 85 1,000 1,085
 Relative Risk (RR)

• Measures how likely the exposed groupwill

develop a disease compared to the
unexposed group.

RR= incidence in the exposed = a/(a+b)

incidence in the unexposed c/(c+d)
 Example: Hypothetical Study

Lung cancer

Yes No Total

Yes 70 300 370

Smoking No 15 700 715

Total 85 1,000 1,085

Relative Risk = 70/(70+300) = 9.0
15/(15+700)

Which means… participants who smoked were 9

times more likely to develop lung cancer than
those who did not smoke.
 Interpreting Measures
of Association

RRof 1.0 indicates that theoccurrence

of disease in the exposed an
unexposed groups are identical:

–No association observed between

exposed and unexposed groups.
 Interpreting Measures
of Association (Continued)

• RRgreater than 1.0 indicates apositive

association, or an increased risk
among the exposed.

• RRless than 1.0 means that there isa

decreased risk among the exposed
group.
 Ukuran-ukuran asosiasi
• Ukuran rasio
– Rasio risiko atau risiko relatif (RR)
Risiko pada kelompok terpajan
RR
Risiko pada kelompok tidak terpajan

– Rasio Insidens Kumulatif(RIK)

Insidens kumulatif pada kelompok terpajan

RIK
Insidens kumulatif pada kelompok tidak terpajan
Perhitungan RR untuk CI
Outcome (+) Outcome (-) Total

E (exposed) a b a+b

NE (unexposed) c d c+d

Total a+c b+d N

(a + b + c + d)

CI pada populasi exposed (E) --- a/(a + b)

RR=
CI pada populasi unexposed (NE) --- c/(c + d)
 THEN, FOLLOW TO SEE WHETHER
Incidenc
Disease Disease e rates
Totals of
Develop Does Not
s Develop Disease

a Incidence in
FIRST, Exposed a b a+ b =
a+b exposed
SELECT
Not c Incidence in
c d c+ d =
Exposed c+d non-exposed

a
Relative Risk ( RR ) = incidence in exposed a+b
incidence in non-exposed
= c
c+d
 Example : A Prospective Study of 3,000 Smokers and 5,000 Non-
smokers to Investigate Smoking and Coronary Heart Disease
(CHD)
THEN FOLLOW UP TO
SEE HOW MANY

Develo Do Not Incidenc

Develo Total e per
p p 1,000 per
CHD CHD year
FIRST,
SELECT Healthy Smokers 84 2,916 3,000 28.0
Healthy Non-Smokers 87 4,913 5,000 17.4
 Contoh 5.
Tabel 1. Kaitan antara merokok dan angka insidens stroke dalam suatu kohort.

Kategori Jumlah kasus Orang-tahun Tingkat

merokok stroke observasi insidens stroke
(lebih dari 8 (per 100.000
tahun) orang tahun)
Tidak pernah
merokok
70 395.594 17,7
Mantan perokok
65 232.712 27,9
Perokok
139 280.141 49,6

Total
274 908.447 30,2
Sumber: diterjemahkan dari:Beaglehole et al. Basic Epidemiology. WHO. 1993. 18.
Postmenopausal Hormone Supplement and CHD
CHD Person-years

Ever use 30 54,308.7

Past use 19 24,386.7
Current 11 29,922.0
Never use 60 51,477.5

RR ever use vs never use = (30/54,308.7) / ( 60/51477.5) = 0.5

RR past use vs never use = (19/24386.7) / (60/51477.5) = 0.7

RR current use vs never use = (11/29922.0) / (60/51477.5) = 0.3

 Ukuran-ukuran asosiasi
• Ukuran rasio
– Rasio odds (Odds ratio =OR)
• Nama lain: Odds relative; rasiokros-produk
• rasio dua odds yang digunakan dalam studi kasus-
kontrol untuk mengestimasi rasio rate atau rasiorisiko
 Ukuran-ukuran asosiasi
• Ukuran rasio
– Rasio odds (Odds ratio =OR)
• odds untuk satu kelompok dibagi dengan oddsuntuk
kelompok yang lain
• Mempunyai interpretasi yang sama seperti risiko
relatif
 Ukuran-ukuran asosiasi
• Odds suatu kejadian
– rasio probabilitas bahwa kejadian terjadi
terhadap probabilitas kejadian tidak terjadi
P
Odds suatu peristiwa
1 P

P = Probabilitas suatu kejadian terjadi

1 –P = Probabilitas suatu kejadian tidak terjadi
Figure 11-5 A, Odds ratio (OR) in a cohort study. B, Odds ratio (OR) in a case-control study.

Downloaded from: StudentConsult (on 8 October 2009 11:44AM)

© 2005 Elsevier
 Prevalence Odds Ratio (POR) = Cross Product Ratio 
bila data didasarkan pada kasus-kasus prevalens
650 x 350
Prevalence Odds Ratio 4,8
950 x 50

650 /1600 0,40625

Prevalence ( proportion) Ratio 3,25
50 / 400 0,125

Faktor Kasus Kontrol Total

Perokok 650 (a) 950 (b) 1600

Bukan 50 (c) 350 (d) 400

perokok
Total 700 1300 2000
 Odds Ratio & RiskRatio
The odds ratio will provide a good estimate of the
risk ratio when:

1. The outcome (disease) is rare a / (a +b )

RR = ------------
D+ D- c / (c+d)
E+ a b If the disease is rare, then
E- c d cells (a) and (c) will besmall

OR = (a / c) / (b / d)
a / (a +b ) a / b ad
OR = (ad) / (bc) RR = ------------ = ------ =-- = OR
c / (c +d) c / d bc
Figure 11-6 Example: The odds ratio is a good estimate of the
relative risk when a disease isinfrequent.
Downloaded from: StudentConsult (on 8 October 2009 11:44AM)
© 2005 Elsevier
Figure 11-7 Example: The odds ratio is not agood
estimate of the relative risk when a disease isnot
infrequent. Downloaded from: StudentConsult (on 8 October 2009 11:44AM)
© 2005 Elsevier
In a prospective study/cohort study,
the Relative Risk can be calculated
directly

In a retrospective study /case control

study , the RR cannot be calculated
directly, so that the Relative Odds or
ODDS RATIO ( Cross Products Ratio )
is used as an estimate of the RR, when
the risk of the disease is low
 OR& RR
• Pada penyakit yang jarang terjadi,nilai Odds
Ratio hampir sama dengan nilai Relative Risk
(Risk Ratio). Nilai Prevalence Odds Ratio
hampir sama dengan nilai Prevalence
Proportion Ratio.

• Pada penyakit yang umum terjadi, nilai Odds

Ratio lebih ekstrim dari pada RiskRatio.
 Interpretation of OddsRatio
• Relative odds associated with exposure
OR =1 no association
OR >1 positive association
OR <1 negative association
• Size of ORindicates strength of association
• OR≈ RRwhen disease rare (i.e., risk < 5%);
when disease not rare, ORstill a validmeasure
of association

Gerstman Chapter 8 (partial) 28