MEASURES OF

ASSOCIATION
LESSON 1
MEASURES OF ASSOCIATION
 Quantifies the relationship between exposure and disease among
two groups

*Exposure is used loosely to mean not only exposure to foods,

mosquitoes, a partner with sexually transmitted disease, or a toxic
waste dump, but also inherent characteristics of a person (age, sex,
race), biological characteristics (occupation, leisure activities), or
conditions under which they live (socioeconomic status or access to
medical care).
I. RISK RATIO (RR)/RELATIVE
RISK
 Compares the risk of a health event (disease, injury, risk factor, or
death) among one group with the risk among another group.
 It does so by dividing the risk (incidence proportion, attack rate) in
group 1 by the risk (incidence proportion, attack rate) in group 2.
 The two groups are typically differentiated by such demographic
factors as sex or by exposure to a suspected risk ratio.
 The group of primary interest is labelled the exposed group and the
comparison group is labelled the unexposed group.
I. RISK RATIO (RR)/RELATIVE
RISK
In an outbreak of TB among prison inmates in South Carolina in 1999, 28 of
157 inmates residing on the East wing of the dormitory developed TB,
compared with 4 of 137 inmates residing on the West wing.

*2-by-2 table contains two rows for the exposure and two columns for the
outcome

Ill Well Total

Exposed a b a+b=H1
Unexposed c d c+d=H0
Total a+c=v1 b+d=v0 Total
I. RISK RATIO (RR)/RELATIVE
RISK
Developed TB?
Yes No Total
East Wing a=28 b=129 H1=157
West Wing c=4 d=133 H2=137
Total 32 262 294
I. RISK RATIO (RR)/RELATIVE
RISK
Attack Rate (Risk)
Attack rate for exposed = a/a+b
Attack rate for unexposed = c/c+d

Risk of TB among East Wing residents = 28/157 = 0.178 = 17.8%

Risk of TB among West Wing residents = 4/137 = 0.029 = 2.9%
Risk ratio = 17.8/2.9 = 6.1
*Therefore, the inmates who resided on the East Wing were 6.1 times as likened to
develop TB as those who resided in the West Wing.
II. RATE RATIO
 Compares the incidence rates, person-time rates, or mortality rates of two
groups.
 The two groups are typically differentiated by demographic factors or by
exposure to a suspected causative agent.

Rate Ratio = Rate for group of primary interest

Rate for comparison group
II. RATE RATIO
Public Health Officials were called to investigate a perceive increase in visits to ships’
infirmities for ARI by passengers of cruise ship in Alaska in 1998. The officials
compared passenger visits to ship infirmities for ARI during May-August 1998 with
the same period in 1997. They recorded 11.6 visits for ARI per 1000 tourists per week
in 1998, compared with 5.3 visits per 1000 tourists per week in 1997.

Rate ratio = 11.6 / 5.3 = 2.2

*Therefore, passengers on cruise ship in Alaska during May-August 1998 were more
than twice as likely to visit their ships’ infirmities for ARI than were passengers in
1997.
III. ODDS RATIO (OR)
 Quantifies the relationship between an exposure with two categories and health outcome.

Odds ratio = (a)(c) = ad/bc

(b)(d)
where:
a = # of persons exposed and with disease
b = # of persons exposed but without disease
c = # of persons unexposed but with disease
d = # of persons unexposed and without disease

Note: a+c = total number of persons with disease (case patient)

b+d = total number of persons without disease (control)
III. ODDS RATIO (OR)
 Sometimes called the cross-product ratio because the numerator is based on multiplying the
value in cell “a” times the value in cell “d”, whereas the denominator is the product of cell “b”
and cell “c”.
Disease No Disease Total
Exposed a=100 b=1900 2000
Not Exposed c=80 d=7920 8000
Total 180 9820 10000

Odd ratio = 100 x 7920 / 1900 x 80 = 5.2