RR and OR
• Relative risk is a ratio of the probability of an event occurring in the
exposed group versus the probability of the event occurring in the non-
exposed group.
• For example, the relative risk of developing lung cancer (event) in
smokers (exposed group) versus non-smokers (non-exposed group)
would be the probability of developing lung cancer for smokers
divided by the probability of developing lung cancer for nonsmokers.
• The relative risk does not provide any information about the absolute
risk of the event occurring, but rather the higher or lower likelihood of
the event in the exposure versus the non-exposure group
(Probability of event in exposed group)
𝑅𝑅 =
Probability of event in not exposed group)
Example
• If we hypothetically find that 17% of smokers develop lung cancer and
1% of non-smokers develop lung cancer, then we can calculate the
relative risk of lung cancer in smokers versus non-smokers as:
(Probability of event in exposed group) 17
𝑅𝑅 = = = 17
Probability of event in not exposed group) 1
Thus, smokers are 17 times more likely to develop lung cancer than non-
smokers.
Example 2
• Fourteen of the volunteers who were given the new medicine have an
upset stomach, and 42 of the volunteers who were given the new
medicine do not have an upset stomach.
• In volunteers who did not take the medication, two people have an
upset stomach, and 83 do not have an upset stomach.
• To calculate the relative risk (RR), first, calculate the probability of
having an upset stomach with exposure to the new medication.
Fourteen people have an upset stomach who were exposed, and 42
people do not have an upset stomach who were exposed.
Solution
• Probability in exposure group = 14 / (14+42) = 14 / 56
= 0.25
Exposed Non total
exposed
Have 14 2 115
Not have 42 83 125 • Probability in non-exposure group = 2 / (2 + 83) = 2 /
Total 56 85 240 85 = 0.024
• Relative Risk = 0.25 / 0.024 = 10.4
𝑎/(𝑎 + 𝑏) 0.25
𝑅𝑅 = = = 10.4
c/ (c+d) 0.024
Conclusion
• Thus, it is 10.4 times more likely to have an upset stomach after taking
the new medicine in this study than if you did not take the new
medicine in the study.
Interpretation of RR
• A relative risk of one implies there is no difference of the event if the
exposure has or has not occurred.
• If the relative risk is greater than 1, then the event is more likely to
occur if there was exposure.
• If the relative risk is less than 1, then the event is less likely to occur if
there was exposure.
• Relative risk is the ratio of the probability of an event occurring with
an exposure versus the probability of the event occurring without the
exposure.
• Thus to calculate the relative risk, we must know the exposure status
of all individuals (either exposed or not exposed).
• This implies that relative risk is only appropriate for cases where the
exposure status and incidence of disease can be accurately determined,
such as prospective cohort studies
The odds ratio
• The odds ratio compares the odds of some event in an exposed group
versus the odds in a non-exposed group and is calculated as the
number of events / the number of non-events.
• Stated another way, if the probability of an event is P, then the odds
ratio would be P / (1 – P).
• In a two-by-two table with cells
a, b, c, and d then the odds ratio
Exposed Non total
exposed
is:
disease 14 2 115 • odds of the event in the
Not 42 83 125 exposure group (a/b) divided by
disease
the odds of the event in the
Total 56 85 240
control or non-exposure group
(c/d).
• Thus the odds ratio is (a/b) / (c/d)
which simplifies to ad/bc.
ODDS RATIO
Not
exposed Total
exposed
disease a b a+b
non disease c d c+d
Total a+c b+d n
ODDS RATIO
To calculate the ODD (disease among the not exposed) we must calculate:
• freq (disease | exposed) = a / (a + c)
• 1 - freq(disease | exposed) = 1- (a / (a + c)) = c / (a + c)
To calculate the ODD (disease among the not exposed) we must calculate:
• freq (disease | not exposed) = b / (b + d)
•1 - freq(disease | not exposed) = 1- b / (b + d) = d / (b + d)
ODDS RATIO
Using these results we can express the odds ratio as:
[ a /( a + c )] /[ c /( a + c )] a/c ad
OR = = =
[b /(b + d )] /[ d /(b + d )] b/d bc
This is the ratio of the cross product of the values
in the initial 2x2 contingency table
Interpretation of ODDS RATIO
Theoretically the Odds Ratio can take values between 0 and + .
Se OR =1 absence of association between disease and
exposure, in fact the odds of disease among those exposed = the
odds of disease among those not exposed.
Se OR <1 association is negative, i.e. the exposure factor can
protect against the disease.
Se OR >1 positive association, the exposure factor can cause
the disease.
Interpretaion of ODDS RATIO
• The interpretation of the odds is carried out according to the
following scheme:
• The higher the OR value, the stronger the association.
