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http://jama.ama-assn.org/cgi/content/full/280/19/1690
Related Letters Correcting the Odds Ratio in Cohort Studies of Common Outcomes
Louise-Anne McNutt et al. JAMA. 1999;282(6):529.
In Reply:
Ravindra L. Mehta et al. JAMA. 2003;289(11):1380.
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Logistic regression is used frequently in cohort studies and clinical trials. When A and Hospital B by comparing neonatal
the incidence of an outcome of interest is common in the study population mortality in very low birthweight neo-
(.10%), the adjusted odds ratio derived from the logistic regression can no nates between these 2 hospitals.2 At first
longer approximate the risk ratio. The more frequent the outcome, the more the glance, Hospital A had a lower mortality
odds ratio overestimates the risk ratio when it is more than 1 or underestimates rate than Hospital B (18% vs 24%, risk
ratio, 18%:24% [0.75]). However, after ad-
it when it is less than 1. We propose a simple method to approximate a risk ra-
justing for clinical variables and initial
tio from the adjusted odds ratio and derive an estimate of an association or disease severity using logistic regression,
treatment effect that better represents the true relative risk. the adjusted odds ratio of Hospital A vs
JAMA. 1998;280:1690-1691
Hospital B was 3.27 (95% confidence in-
terval, 1.35-7.92). Can one therefore con-
RELATIVE RISK has become one of hort studies.1 However, logistic regres- clude that neonates with very low birth-
the standard measures in biomedical re- sion yields an odds ratio rather than a risk weight in Hospital A had 3 times the risk
search. It usually means the multiple of ratio, even in a cohort study. Under the of death than those in Hospital B? Prob-
risk of the outcome in one group com- same rule, when the outcome of interest ably not, because the outcome (neonatal
pared with another group and is ex- is common in the study population death) was common in this study popula-
pressed as the risk ratio in cohort stud- (though it could be rare in the general tion. To provide a measure that more ac-
ies and clinical trials. When the risk ratio population), the adjusted odds ratio from curately represents the concept of rela-
cannot be obtained directly (such as in a the logistic regression may exaggerate a tive risk, correction of the odds ratio may
case-control study), the odds ratio is cal- risk association or a treatment effect. For be desirable.
culated and often interpreted as if it instance, a previous study assessed the A modified logistic regression with
were the risk ratio. Subsequently, the performance of neonatal units in Hospital special macro functions has been devel-
term relative risk commonly refers to
either the risk ratio or the odds ratio.
However, only under certain conditions 10
does the odds ratio approximate the risk RR = 3.0
ratio. The Figure shows that when the RR = 2.5
incidence of an outcome of interest in the 5
RR = 2.0
study population is low (,10%), the odds
RR = 1.75
ratio is close to the risk ratio. However, 3
the more frequent the outcome becomes, RR = 1.5
2
the more the odds ratio will overesti- RR = 1.25
Odds Ratio
1690 JAMA, November 18, 1998—Vol 280, No. 19 What’s the Relative Risk?—Zhang & Yu
JAMA, November 18, 1998—Vol 280, No. 19 What’s the Relative Risk?—Zhang & Yu 1691
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