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Measures of Impact

Lyle Petersen 1999, Thomas Grein 2000-2003

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•  You are in charge of health prevention

• ant to re!uce automo"ile-relate! !eaths

• #ave a limite! "u!get "ut $ant to have the greatest impacton re!ucing !eaths

• %on!uct a cohort stu!y to e&amine causes for automo"ile-relate! !eaths

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RR = 5.0

0.00000050

0.00000010

0.500.10

% exposedto riskfactor?

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Measures of Impact

• 'easures of association provi!ing information

a"out a"solute effects of e&posure

• T$o concepts- (ttri"uta"le ris) among e&pose!

- Population attri"uta"le ris)

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Attributable Risk (AR)

• *uantifies !isease "ur!en in e&pose! group

attri"uta"le to e&posure

• Provi!es ans$ers to

- hat is the ris) $hich can "e attri"ute! to thee&posure+

- hat is the e&cess ris) !ue to the e&posure+

• %alculate! as ris) !ifference ./

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Attributable Risk 

nci!ence

&pose! ne&pose!

e&pose!  une&pose!

I = Incidence

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.ea! 4ot !ea! is) .

5ast 100 1900 2000 0607

 0608

lo$ :0 ;920 :000 0601

  1:0 9:20 10000

AR !ast dri"i#$

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.ea! 4ot !ea! is) .

5ast 100 1900 2000 0607

 0608

lo$ :0 ;920 :000 0601

  1:0 9:20 10000

AR !ast dri"i#$

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.run) 87 277 300 06170

0613<

4ot !6 137 97<7 9;00 06018

  1:0 9:20 10000

AR ru#k dri"i#$

.ea! 4ot !ea! is) .

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.run) 87 277 300 06170

0613<

4ot !6 137 97<7 9;00 06018

  1:0 9:20 10000

AR ru#k dri"i#$

.ea! 4ot !ea! is) .

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Attributable Risk &erce#t (AR%)

• ( e&presse! as a percentage of ris) in e&pose!

• Provi!es ans$ers to

- hat is the proportion of !isease among the e&pose!

$hich =

  can "e attri"ute! to the e&posure+

  coul! "e avoi!e! "y eliminating the e&posure+

• ynonyms

- (ttri"uta"le proportion

- tiologic fraction 5/

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Attributable Risk &erce#t

nci!ence

&pose! ne&pose!

%e&pose!

une&pose!e&pose!

-100&

1-=

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.ea! 4ot !ea! is) (>

5ast 100 1900 2000 06070

06070- 06010  06070

  ? :0>

lo$ :0 ;920 :000 06010

  1:0 9:20 10000

AR% !ast dri"i#$

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.ea! 4ot !ea! is) (>

.run) 87 277 300 06170

4ot !6 137 97<7 9;00 06018

  1:0 9:20 10000

AR% ru#k dri"i#$

06170- 06018

  06170

  ? 91>

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AR ' AR% i# aseo#trol*tudies

• 4o !irect ris) estimates in case-control stu!y

- 4o calculation of ( ris) !ifference/ an! (> possi"le

• f o!!s ratio appro&imates relative ris), then

100& @

1-@(> =

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&re"e#ted !ractio# (&!)

• f relative ris) A1

- Proportion of potential ne$ cases $hich $oul! have

occurre! if the e&posure ha! "een a"sent

- Proportion of potential cases prevente! "y the e&posure

-1 

 - P5

une&pose!

e&pose!une&pose!

=

=

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&! +acci#e e,cac-

  Pop6 %ases %asesB1000

Caccinate! 301,787 170 0689 062:

nvaccinate! 29:,<77 717 16;2 ef6

Total <00,200 <<7 1611

06;2 062:-1 

06;216;2

0689-16;2 P5

==

==

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&pecte! num"er of cases among

vaccinate! if unvaccinate!

@"serve! num"er of cases 150

stimate! num"er of cases prevente! 369 (72%)

519 1.72x1,000

301,545=

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• &cess ris) of !isease in total population

attri"uta"le to e&posure

• e!uction in ris) $hich $oul! "e achieve! if

population entirely une&pose!• #elps !etermining $hich e&posures relevant to

pu"lic health in community

&opulatio# Attributable Risk (&AR)

 

une&pose!population -P( =

 e&pose!/,P (/  (=

P = proportion

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&opulatio# Attributable Risk 

is)

Population ne&pose!

une&pose!population -

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is)

Population ne&pose!

is)

&pose! 2ne&pose!

• &> e&pose!

  • (100&/ >

une&pose!

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• P( e&presse! as a precentage of total ris) in

population

&opulatio# Attributable Risk&erce#t (&AR%)

100&

 - P(>population

une&pose!population=

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.ea! 4ot !ea! is)

5ast 100 1900 2000 06070

lo$ :0 ;920 :000 06010

  1:0 9:20 10000 0601:

&AR !ast dri"i#$

88>100&0601:

06010-0601: P(>   ==

0600: 06010-0601: P( ==

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.ea! 4ot !ea! is)

.run) 87 277 300 06170

4ot !6 137 97<7 9;00 06018

  1:0 9:20 10000 0601:

&AR ru#k dri"i#$

22> 100&0601:

06018-0601: P(>   ==

0600806018-0601: P( ==

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o#clude

• 88> of !riving-relate! !eaths in population $ere

presuma"ly !ue to fast !riving

• 22> of !riving-relate! !eaths in population $erepresuma"ly !ue to !run) !riving

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&AR% i# aseo#trol *tudies

• %ohort stu!y

• %ase-control stu!y

f > controls e&pose! > population e&pose!D

$here P ? > population e&pose!

$here Pcon ? > controls e&pose!

100&11/-,P

1/-,P P(>

+

=

100&11/-,@P

1/-,@P P(>

con

con

+

=

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*ummar-

here $ill you put your money to have the greatest

impact on re!ucing automo"ile-relate! !eaths+

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Associatio# betee# smoki#$a#d lu#$ ca#cer (case stud-)

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Associatio# betee# smoki#$a#d cardio"ascular disease

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*moki#$ a#d mortalit- due to + disease a#d lu#$ ca#cer

"ase! on 102,<00 PY, there $ere 133 !eaths !ue to lung cancer

an! 9;< !eaths !ue to car!iovascular !isease

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/at is te AppropriateMeasure?

• E%ontrol of prostitution $ill prevent most

heterose&ual #C transmissionF

• E#e got lung cancer6 Hut he pro"a"ly $oul! havegotten lung cancer any$ay even if he !i!nIt

smo)e6

• Ehoul! fly (ngolan (irlines or *uantas+E