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Relativerisk
FromWikipedia,thefreeencyclopedia

Instatisticsandepidemiology,relativeriskorriskratio(RR)istheratiooftheprobabilityofaneventoccurring
(forexample,developingadisease,beinginjured)inanexposedgrouptotheprobabilityoftheeventoccurringin
acomparison,nonexposedgroup.Relativeriskincludestwoimportantfeatures:(i)acomparisonofriskbetween
two"exposures"putsrisksincontext,and(ii)"exposure"isensuredbyhavingproperdenominatorsforeachgroup
representingtheexposure[1][2]

Consideranexamplewheretheprobabilityofdevelopinglungcanceramong
smokerswas20%andamongnonsmokers1%.Thissituationisexpressedinthe Diseasestatus
22tabletotheright. Risk
Present Absent
Here,a=20,b=80,c=1,andd=99.Thentherelativeriskofcancerassociated Smoker
withsmokingwouldbe Nonsmoker

Smokerswouldbetwentytimesaslikelyasnonsmokerstodeveloplungcancer.

Thealternativetermriskratioissometimesusedbecauseitistheratiooftheriskintheexposeddividedbythe
riskintheunexposed.

Relativeriskcontrastswiththeactualorabsoluterisk,andmaybeconfusedwithitinthemediaorelsewhere.

Contents
1 Statisticaluseandmeaning
1.1 Bayesianinterpretation
1.2 Logtransformationforapproximatinganormaldistribution
1.3 Comparisontotheoddsratio
1.4 Statisticalsignificance(confidence)andrelativerisk
1.5 Tests
2 Workedexample
3 Seealso
3.1 Statisticalratios
4 References
5 Externallinks

Statisticaluseandmeaning

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Relativeriskisusedfrequentlyinthestatisticalanalysisofbinaryoutcomeswheretheoutcomeofinteresthas
relativelylowprobability.Itisthusoftensuitedtoclinicaltrialdata,whereitisusedtocomparetheriskof
developingadisease,inpeoplenotreceivingthenewmedicaltreatment(orreceivingaplacebo)versuspeople
whoarereceivinganestablished(standardofcare)treatment.Alternatively,itisusedtocomparetheriskof
developingasideeffectinpeoplereceivingadrugascomparedtothepeoplewhoarenotreceivingthetreatment
(orreceivingaplacebo).Itisparticularlyattractivebecauseitcanbecalculatedbyhandinthesimplecase,butis
alsoamenabletoregressionmodelling,typicallyinaPoissonregressionframework.

Inasimplecomparisonbetweenanexperimentalgroupandacontrolgroup:

Arelativeriskof1meansthereisnodifferenceinriskbetweenthetwogroups.
AnRRof<1meanstheeventislesslikelytooccurintheexperimentalgroupthaninthecontrolgroup.
AnRRof>1meanstheeventismorelikelytooccurintheexperimentalgroupthaninthecontrolgroup.

Bayesianinterpretation

Wecouldassumeadiseasenotedby ,andnodiseasenotedby ,exposurenotedby ,andnoexposurenoted

by .Relativeriskcanbewrittenas

Substituting and

Inotherwords,youcanseetherelativeriskinbayesiantermsastheposteriorratiooftheexposure(i.e.after
seeingthedisease)normalisedbythepriorratioofexposure.[3]Insimpleterms,iftheposteriorratioofexposureis
similartothatoftheprior,Iwillendupwithanequaleffect,or1,indicatingnoassociationwiththedisease,
sinceitdidn'tchangemybeliefsoftheexposure.Ifontheotherhandtheposteriorratioofexposureissmalleror
greaterthanthatofthepriorratio,thenthediseasehavechangedmyviewoftheexposuredanger,andthe
magnitudeofthischangeistherelativerisk.

Theoddsratiocanbethenviewedinsimilartermsasfollows

orcanbealternativelydefinedintermsofexposuresimilartotheabovedefinitionas

Logtransformationforapproximatinganormaldistribution

AsaconsequenceoftheDeltamethod,thelogoftherelativeriskhasasamplingdistributionthatisapproximately
normalwithvariancethatcanbeestimatedbyaformulainvolvingthenumberofsubjectsineachgroupandthe
eventratesineachgroup(seeDeltamethod).[4]Thispermitstheconstructionofaconfidenceinterval(CI)whichis
symmetricaroundlog(RR),i.e.,
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where isthestandardscoreforthechosenlevelofsignificanceandSEthestandarderror.Theantilogcanbe
takenofthetwoboundsofthelogCI,givingthehighandlowboundsforanasymmetricconfidenceinterval
aroundtherelativerisk.

Inregressionmodels,thetreatmentistypicallyincludedasadummyvariablealongwithotherfactorsthatmay
affectrisk.Therelativeriskisnormallyreportedascalculatedforthemeanofthesamplevaluesoftheexplanatory
variables.

Comparisontotheoddsratio

Relativeriskisdifferentfromtheoddsratio,althoughitasymptoticallyapproachesitforsmallprobabilities.Inthe
exampleofassociationofsmokingtolungcancerconsideredabove,ifaissubstantiallysmallerthanb,then
a/(a+b) a/b.Andifsimilarlycismuchsmallerthand,thenc/(c+d) c/d.Thus

Thisistheoddsratio.

Infact,theoddsratiohasmuchwideruseinstatistics,sincelogisticregression,oftenassociatedwithclinicaltrials,
workswiththelogoftheoddsratio,notrelativerisk.Becausethelogoftheoddsratioisestimatedasalinear
functionoftheexplanatoryvariables,theestimatedoddsratiofor70yearoldsand60yearoldsassociatedwith
typeoftreatmentwouldbethesameinalogisticregressionmodelswheretheoutcomeisassociatedwithdrugand
age,althoughtherelativeriskmightbesignificantlydifferent.Incaseslikethis,statisticalmodelsoftheoddsratio
oftenreflecttheunderlyingmechanismsmoreeffectively.

Sincerelativeriskisamoreintuitivemeasureofeffectiveness,thedistinctionisimportantespeciallyincasesof
mediumtohighprobabilities.IfactionAcarriesariskof99.9%andactionBariskof99.0%thentherelativerisk
isjustover1,whiletheoddsassociatedwithactionAaremorethan10timeshigherthantheoddswithB.

Inepidemiologicalresearch,theoddsratioiscommonlyusedforcasecontrolstudies,asodds,butnot
probabilities,areusuallyestimated.[5]Relativeriskisusedinrandomizedcontrolledtrialsandcohortstudies.[6]

Instatisticalmodelling,approacheslikepoissonregression(forcountsofeventsperunitexposure)haverelative
riskinterpretations:theestimatedeffectofanexplanatoryvariableismultiplicativeontherate,andthusleadstoa
riskratioorrelativerisk.Logisticregression(forbinaryoutcomes,orcountsofsuccessesoutofanumberoftrials)
mustbeinterpretedinoddsratioterms:theeffectofanexplanatoryvariableismultiplicativeontheoddsandthus
leadstoanoddsratio.

Statisticalsignificance(confidence)andrelativerisk

Whetheragivenrelativeriskcanbeconsideredstatisticallysignificantisdependentontherelativedifference
betweentheconditionscompared,theamountofmeasurementandthenoiseassociatedwiththemeasurement(of
theeventsconsidered).Inotherwords,theconfidenceonehas,inagivenrelativeriskbeingnonrandom(i.e.itis
notaconsequenceofchance),dependsonthesignaltonoiseratioandthesamplesize.

Expressedmathematically,theconfidencethataresultisnotbyrandomchanceisgivenbythefollowingformula
bySackett:[7]

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Forclarity,theaboveformulaispresentedintabularformbelow.

Dependenceofconfidencewithnoise,signalandsamplesize(tabularform)

Parameter Parameterincreases Parameterdecreases

Noise Confidencedecreases Confidenceincreases
Signal Confidenceincreases Confidencedecreases
Samplesize Confidenceincreases Confidencedecreases

Inwords,theconfidenceishigherifthenoiseislowerand/orthesamplesizeislargerand/ortheeffectsize
(signal)isincreased.Theconfidenceofarelativeriskvalue(anditsassociatedconfidenceinterval)isnot
dependentoneffectsizealone.Ifthesamplesizeislargeandthenoiseislowasmalleffectsizecanbemeasured
withgreatconfidence.Whetherasmalleffectsizeisconsideredimportantisdependentonthecontextofthe
eventscompared.

Inmedicine,smalleffectsizes(reflectedbysmallrelativeriskvalues)areusuallyconsideredclinicallyrelevant(if
thereisgreatconfidenceinthem)andarefrequentlyusedtoguidetreatmentdecisions.Arelativeriskof1.10may
seemverysmall,butoveralargenumberofpatientswillmakeanoticeabledifference.Whetheragiventreatment
isconsideredaworthyendeavourisdependentontherisks,benefitsandcosts.

Tests

ThedistributionofthelogRelativeRiskisapproximatelynormalwith:

Thestandarderrorforthelog(RelativeRisk)isapproximately:[8]

Thisisanasymptoticapproximation.

Theriskratioconfidenceintervalsarebasedonthesamplingdistributionof

Thisisconsideredtobe(approximately)normalwith

and

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wheremisthemeanands2isthevariance.Approximate95%confidenceintervals(CI)fortherelativeriskare

Inapplicationsusingthisestimatorthesamplesizeshouldbeatleast25.

Workedexample
Example1:riskreduction Example2:riskincrease
Experimentalgroup(E) Controlgroup(C) Total (E) (C) Total
Events(E) EE=15 CE=100 115 EE=75 CE=100 175
Nonevents
EN=135 CN=150 285 EN=75 CN=150 225
(N)
Totalsubjects
ES=EE+EN=150 CS=CE+CN=250 400 ES=150 CS=250 400
(S)
Eventrate EER=EE/ES=0.1,or CER=CE/CS=0.4,or EER=0.5 CER=0.4
(ER) 10% 40% (50%) (40%)

Equation Variable Abbr. Example1 Example2

<0:absoluteriskreduction ARR ()0.3,or()30% N/A
EERCER
>0:absoluteriskincrease ARI N/A 0.1,or10%
<0:relativeriskreduction RRR ()0.75,or()75% N/A
(EERCER)/CER
>0:relativeriskincrease RRI N/A 0.25,or25%
<0:numberneededtotreat NNT ()3.33 N/A
1/(EERCER)
>0:numberneededtoharm NNH N/A 10
EER/CER relativerisk RR 0.25 1.25
(EE/EN)/(CE/CN) oddsratio OR 0.167 1.5
EERCER attributablerisk AR ()0.30,or()30% 0.1,or10%
(RR1)/RR attributableriskpercent ARP N/A 20%
1RR(or1OR) preventivefraction PF 0.75,or75% N/A

Example3:Ratiosarepresentedforeachofexperimentalandcontrolgroups.Inthediseaserisk22
tableabove,supposea+c=1andb+d=1andthetotalnumberofpatientsandhealthypeoplebemandn,
respectively.Thenprevalenceratiobecomesp=m/(m+n).Wecanputq=m/n=p/(1p).Thus

Ifpissmallenough,thenqwouldbesmallenoughandeitherof(b/d)qand(a/c)qwouldbesmallenoughto
beregardedas0comparedwith1.RRwouldbereducedtotheoddratioasabove.

AmongJapanese,notasmallfractionofpatientsofBehet'sdiseasearebestowedwithaspecificHLAtype,
namelyHLAB51gene.[9]Inasurvey,theproportionis63%ofthepatientswiththisgene,whileinhealthy
peopletheratiois21%.[9]IfthefiguresareconsideredtoberepresentativeformostJapanese,usingthe

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valuesof12,700patientsinJapanin1984andtheJapanesepopulationabout120millionin1982,then
RR=6.40.Comparewiththeoddratio6.41.

Seealso
Absoluteriskreduction
WikimediaCommonshas
(Population)attributablerisk
mediarelatedtoStatistics
Confidenceinterval forrelativerisk.
Numberneededtotreat(NNT)
Numberneededtoharm(NNH)
OpenEpi
EpiInfo
Therarediseaseassumption

Statisticalratios
Bayesfactor
Hazardratio
Oddsratio

References
1.SistromCL,GarvanCW(January2004)."Proportions,odds,andrisk".Radiology.230(1):1219.
doi:10.1148/radiol.2301031028.PMID14695382.
2.Weddell,Angie."EvidencefromSafetyResearchtoUpdateCyclingTrainingMaterialsinCanada"(PDF).Universityof
BritishColumbia.Retrieved30September2013.
3.StatisticalMethodsinMedicalResearch,FourthEditionhttp://onlinelibrary.wiley.com/book/10.1002/9780470773666
4.Seee.g.StataFAQonCIsforoddsratios,hazardratios,IRRsandRRRsat
https://www.stata.com/support/faqs/stat/2deltameth.html
5.DeeksJ(1998)."Whencanoddsratiosmislead?Oddsratiosshouldbeusedonlyincasecontrolstudiesandlogistic
regressionanalyses".BMJ.317(7166):11556.doi:10.1136/bmj.317.7166.1155a.PMC1114127 .PMID9784470.
6."Oddsratioversusrelativerisk".MedicalUniversityofSouthCarolina.Archivedfromtheoriginalon30April2009.
RetrievedSeptember8,2005.
7."Whyrandomizedcontrolledtrialsfailbutneedn't:2.Failuretoemployphysiologicalstatistics,ortheonlyformulaa
cliniciantrialistiseverlikelytoneed(orunderstand!)".165(9).October2001:122637.PMC81587 .
PMID11706914.
8.Jewell,NicholasP.(2004).Statisticsforepidemiology.BocaRaton:Chapman&Hall/CRC.ISBN9781584884330.
9.OhnoS,OhguchiM,HiroseS,MatsudaH,WakisakaA,AizawaM(1982)."CloseassociationofHLABW51,MT2and
Behet'sdisease,"InInaba,G,ed.(1982).Behet'sDisease:PathogeneticMechanismandClinicalFuture:Proceedings
oftheInternationalConferenceonBehet'sDisease,heldOctober2324,1981,pp.7379,Tokyo:UniversityofTokyo
Press,ISBN0860083225.

Externallinks
EBMglossary(http://www.cebm.utoronto.ca/glossary/)
Relativeriskonlinecalculator(http://www.medcalc.org/calc/relative_risk.php)

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Categories: Epidemiology Biostatistics Medicalstatistics Statisticalratios

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