MEASURE OF ASSOCIATIONS
VICTORIA INSTITUTE OF SCIENCE AND TECHNOLOGY
LECTURER: MUSLIH ABDULLA KHAMIS
Outline
By the end of this session, students are expected to be able to:
oGive different examples of exposures and outcome
oDescribe a two by two table
oCalculate a risk factor
oCalculate a relative risk
oCalculate odds ratio
Measure of Association
• Is a statistical tool used in epidemiology and public health
research to quantify the strength and direction of the
relationship between an exposure and an outcome.
• It answers the question:
"Is there a link between a risk factor (exposure) and a health
condition (outcome)? If so, how strong is it?"
Examples of Exposure and Outcome
Exposure Outcome
Smoking Lung cancer
Sedentary lifestyle Cardiovascular disease
Use of mosquito nets Reduced malaria incidence
Alcohol use during pregnancy Fetal alcohol syndrome
Antibiotic overuse Antimicrobial resistance
Reduced infant gastrointestinal
Breastfeeding
infections
Uses of Measures of Association
• Helps determine causal relationships.
• Informs public health interventions, policies, and clinical
decisions.
• Used to evaluate effectiveness of treatments, risk factors, or
protective behaviors.
Main Types of Measures of Association
• Risk Ratio (Relative Risk - RR)
• Odds Ratio (OR)
• Risk Difference (Attributable Risk)
• Prevalence Ratio
• Hazard Ratio (HR)
Two-by-Two (2x2) Table
Outcome Present Outcome Absent Total
Exposure Present A B A+ B
Exposure Absent C D C+D
Total A+ C B+D A+ B+ C+ D
Two-by-Two (2x2) Table…
Where:
• A = Exposed + Outcome
• B = Exposed + No Outcome
• C = Not Exposed + Outcome
• D = Not Exposed + No Outcome
Calculate Risk Factor (Incidence)
• Risk (Incidence) = Number of people who develop the
outcome / Total at risk
• Risk among exposed = A / (A + B)
• Risk among unexposed = C / (C + D)
Calculate Relative Risk (RR)
RR =
RR =
• Interpretation:
• RR = 1 → No association
• RR > 1 → Positive association (risk increased by exposure)
• RR < 1 → Negative association (protective effect)
Calculate Odds Ratio (OR)
Odds of exposed =
Odds of unexposed = =
Odds ratio (OR)
Odds Ratio
OR =
• Often used in case-control studies.
• Interpretation similar to RR.
Example: A study on aspirin use and heart attack occurrence
in 200 patients.
Heart Attack (Yes) Heart Attack (No) Total
Took Aspirin
10 90 100
(Exposed)
Did Not Take Aspirin 25 75 100
Calculate Risk (Cumulative Incidence)
• Risk among aspirin users = 10 / 100 = 0.10 (10%)
• Risk among non-users = 25 / 100 = 0.25 (25%)
Calculate Relative Risk (RR)
RR = 0.10 / 0.25 = 0.4
Interpretation:
• Aspirin users are 60% less likely to have a heart attack
compared to non-users.
• If RR = 1 → No association
• If RR > 1 → Positive association (risk factor)
• If RR < 1 → Negative association (protective factor)
Calculate Odds Ratio (OR)
OR = (10 × 75) / (90 × 25) = 750 / 2250 = 0.33
Interpretation:
• The odds of heart attack in aspirin users is about 1/3 that of
non-users.
• Useful in case-control studies where risk cannot be directly
measured.
EXERCISE
• Imagine a cohort study of 1,000 people:
• 500 are smokers
• 500 are non-smokers
• Over 10 years, 50 smokers and 10 non-smokers develop lung
cancer
• Calculate risk, relative risk and odds ratio
Summary
Measures of Association tell us:
• Whether an exposure increases, decreases, or has no
effect on the risk of an outcome.
• How strong that relationship is.
