Basic Risk Measurement
Basic Risk Measurement
Risk is essentially a measure of probability.
Probability is a measure of uncertainty.
It is often expressed as a relative frequency: of
all the possible events, how likely is it that the
event under consideration will occur?
Probability refers to future events, but it is
estimated from our past experience.
Basic Risk Measurement
For example, in a clinical trial, if 60% of the
people taking a medication find relief from
their symptoms, one estimates that the
probability of symptom relief in future is 60%
(for every 100 patients with the condition
taking this medication, 60 will show relief).
Basic Risk Measurement
Three basic laws of probability are used in calculations of
probability:
1. Probability is between 0 and 1
2. P(A or B) = P(A) + P(B) if A and B are mutually exclusive
= P(A) + P(B) – P(A and B) if they are not
3. P(A and B) = P(A) x P(B) if they are ‘independent’
= P(B) x P(A|B) if they are not.
Repeated use of the above rules allows one to compute probabilities
for various events in epidemiological studies, and to calculate the
appropriate risk estimates and their standard errors.
Basic Risk Measurement
Use of probability in diagnostic tools
The accuracy of diagnostic tools is often measured by
how often the diagnosis correctly identifies diseased
people (sensitivity of the test) and how often the tool
identifies those who are well (specificity of the test).
From these measures, the predictive value of a
positive or negative test can be derived.
Use of probability to assess risks in
epidemiological studies
1. Incidence and prevalence
- two commonly used measures to determine
the risk of the probability of disease (or any
outcome of interest).
Prevalence measures the probability of having
a disease
Incidence measures the probability of getting a
disease.
Use of probability to assess risks in
epidemiological studies
These can be expressed formally as:
Point prevalence =no. of people with the disease (outcome) in a
population at a specific point in time / total population at risk at that
time
Period prevalence = no. of people with the disease in a population
during a specific period / total population at risk during that period
In both cases, the numerator is the number of existing cases.
This is the measure that is available in a cross-sectional study.
Use of probability to assess risks in
epidemiological studies
Incidence, on the other hand, has the number of new cases in the
numerator.
Two ways of measuring incidence:
a. Cumulative incidence = no. of new cases/total number of individuals
in the population at risk for a specific time interval
b. Incidence density = no. of new cases/total number of individuals in
the population at risk per time interval
Use of probability to assess risks in
epidemiological studies
2. Measures (indices) of association
In Cohort Studies:
When the probabilities of disease in two groups are
compared, and the probability of disease among the exposed
group is compared with the probability of disease among the
unexposed, a relative measure is used. The ratio of the two
probabilities is called the relative risk (RR).
RR = incidence among exposed / incidence among the
unexposed
Use of probability to assess risks in
epidemiological studies
Use of probability to assess risks in
epidemiological studies
Use of probability to assess risks in
epidemiological studies
An RR of more than 1 indicates the factor to
be positively associated with the disease
(exposure increases the chance of the disease,
e.g. smoking)
RR of less than 1 indicates a protective factor
(exposure decreases the chance of disease, e.g.
vaccination).
Use of probability to assess risks in
epidemiological studies
Another measure that is commonly derived from the
probabilities of disease in the two groups, is the attributable
risk (AR): the excess risk for the exposed group compared
with the unexposed group.
This is simply the difference between the two probabilities:
AR = Ie - Io = 0.30 - 0.05 = 0.25
-Twenty-five per cent of the new cases of hypertension
among the exposed group can be attributed to smoking.
In Cohort Studies
In Case-control Studies
We use the odd ratio as a measure of association of
the disease and the risk factor.
OR = ad/bc
Use of probability to assess risks in
epidemiological studies
For example, if the following results were obtained from a case-
control study of 150 cases of hypertension and 850 people without
hypertension, the table would appear as follows:
In Cross-sectional Studies
The population sampled is the total population. Therefore,
both the prevalence of disease and the prevalence of the
risk factor can be estimated.
Note, however, that the probabilities are not ‘risk of
acquiring the disease’, but rather the prevalence measure.
The RR and OR would be calculated in the same way, and
other quantities such as the AR and EF can also be
calculated.
If the prevalence and incidence are similar, these measures
may have the same interpretations.
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