30101-30111 - Absolute Relative and Attributable Risks...

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Absolute, Relative and  Attributable Risks International Society for Nurses in Genetics May 2007 Jan Dorman, PhD University of Pittsburgh Pittsburgh, PA USA
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Objectives Define measures of absolute, relative and attributable risk Identify major epidemiology study designs Estimate absolute, relative and attributable risks from  studies in the epidemiology literature  Interpret risk estimates for patients and apply them in  clinical practice
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Clinical Epidemiology is Science of making predictions about individual patients by  counting clinical events in similar patients, using strong  scientific methods  for studies of groups of patients  to ensure  that predictions are accurate Important approach to obtaining the kind of information  clinicians need to make good decisions in the care of their  patients Sounds like evidence based practice! Fletcher, Fletcher & Wagner, 1996
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Considerations  Patient’s prognosis is expressed as probabilities –  estimated by past experience Individual clinical observations can be subjective and  affected by variables that can cause misleading  conclusions Clinicians should rely on observations based on  investigations using sound scientific principles, including  ways to reduce bias Fletcher, Fletcher & Wagner, 1996
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Epidemiology is Process by which public health problems  are detected,  investigated, and analyzed Risk estimates Based on large populations , not patients or their  caregivers Potential bias and confounding are major issues to be  considered Scientific basis of public health
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Objectives of Epidemiology To determine the rates of disease by person, place and time Absolute risk (incidence, prevalence) To identify the risk factors for the disease Relative risk (or odds ratio) To develop approaches for disease prevention Attributable risk/fraction
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To determine the rates of disease by  person, place, & time Absolute risk (incidence, prevalence) Incidence = number of new  cases of a disease occurring  in a specified time period divided by the number of  individuals at risk of developing the disease during the  same time Prevalence = total  number of affected individuals in a  population at a specified time period divided by the  number of individuals in the population at the time Incidence is most relevant clinically
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To identify the risk factors for the disease Relative risk (RR), odds ratio (OR) RR = ratio of incidence of disease in exposed individuals to  the incidence of disease in non-exposed individuals (from a  cohort/prospective study) If RR > 1, there is a positive association
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