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Populasi dan Sampel

Putri Eyanoer, MD.,Ms.Epi.,Ph.D.


Fotarisman Zaluchu

Populasi dan Sampel


Fotarisman Zaluchu
The likelihood of people exposed to risk factors will
subsequently develop a particular disease
NO RISK= 0
RISK PRESENCE = 1
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

HELP

HEALTHY
RISK
FACTORS

PROBABI
LITY

SICK

Long latency diseases


Frequent exposures to risk factors
Low incidence of disease
Small risk
Common disease
Multiple cause and effects

Populasi dan Sampel


Fotarisman Zaluchu

Prediction
Cause
Diagnosis

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

Populasi dan Sampel


Fotarisman Zaluchu

Experiments take decades


Un-ethical to impose exposure
Reluctantly responds

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

Populasi dan Sampel


Fotarisman Zaluchu

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

Populasi dan Sampel


Fotarisman Zaluchu

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

Populasi dan Sampel


Fotarisman Zaluchu

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

Populasi dan Sampel


Fotarisman Zaluchu

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

CASE CONTROL

COHORT

Populasi dan Sampel


Fotarisman Zaluchu

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

Informative: estimates the association between an


exposure & the risk of developing a disease
Accomplish by:
Calculating the ratio of the measures of disease
frequency for the 2 population
Calculating the difference between the 2
population

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

contingency table of case control study


MCI (+)

MCI (-)

Total

OC use (+)

23

304

327

OC use (-)

133

2816

2949

total

156

3120

3276

contingency table of cohort study


bac (+)

bac (-)

Total

OC use (+)

27

455

482

OC use (-)

77

1831

1908

Total

104

2286

2390

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

contingency table of case control study


Disease(+)

Disease(-)

Person- time
unit

Exposure(+)

--

PY1

Exposure (-)

--

PY0

Total

HRT(+)
HRT (-)
Total

a+c

PY1+PY0

CHD(+)

CHD(-)

Persontime unit

30
60
90

---

54,308.7
51,477.5
105,786.2

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

Estimates the magnitude of an association between


exposure & disease & indicates the likelihood of
developing the disease in the exposed group relative
to those who are not exposed
The ratio of incidence in the exposed (Ie)divided by
the corresponding incidence in the unexposed (I0)
RR = Ie = CIe = a/(a+b)
I0 CI0 c/(c+d)
RR = Ie = IDe = a/(PY1)
I0 ID0 c/(PY0)
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

RR = 1
indicates no association
Incidence rates expose = unexposed
RR > 1
Indicates positive association
Increase risk among exposed to a factor
RR < 1
Indicates inverse association
Decrease risk among those exposed

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

In case control study:


Participants selected on the basis of
disease status
Not possible to calculate the rate of
development of disease given the
presence or absence of exposure
RR estimates by calculating the ratio of the
odds of exposure among cases to control
RR OR = a/c = ad
b/d bc

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

Calculation of OR & RR from a hypothetical data of a cc-study


of smoking and lung CA among 100 cases and 100 controls
Lung CA
(cases)

Lung CA
(control)

Total

Smoking (+)

70

30

100

Smoking (-)

30

70

100

100

100

200

Total

OR = ad = (70)(70) = 5.4
bc

(30)(30)

RR = a/(a+b) = 70/100 = 2.3


c/(c+d)

30/100
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

Calculation of OR & RR from a hypothetical data of a cc-study


of smoking and lung CA among 100 cases and 1000 controls
Lung CA
(cases)

Lung CA
(control)

Total

Smoking (+)

70

300

370

Smoking (-)

30

700

730

100

1000

1100

Total

OR = ad = (70)(700) = 5.4
bc

(30)(300)

RR = a/(a+b) = 70/370 = 4.6


c/(c+d)

30/730
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

A measure of association that provides


information about the absolute effect of the
exposure or the excess risk of disease in
exposed compared with unexposed
Difference between incidence rates in two
groups (Risk difference)
AR = Ie I0

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

In cohort study
AR
= CIe CI0
= a/(a+b) c/(c+d)
OC
(+)
AR
= 27/482 77/1908 OC
(-)
= 0.0156
= 1566/105
Total

bac
(+)

bac
(-)

Total

27

455

482

77

1831 1908

104

2286 2390

Thus, excess occurrence of bacteriuria among OC users


attributable to their OC use is 1566 per 100,000 person
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

AR expressed as percentage
bac
AR%
(+)
= AR / Ie x 100%
27
= (Ie I0) / Ie x 100% OC
(+)
5
= 1566/10 x 100%
OC
77
27/482
(-)
= 27.96%
Total

104

bac
(-)

Total

455

482

1831 1908
2286 2390

Thus, excess occurrence of bacteriuria among OC users


attributable to their OC use is 1566 per 100,000 person
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

AR quantifies the risk of disease in the


expose group that can be considered
attributable to the exposure by removing the
risk of disease that would have occurred
anyway due to other cause
Thus, no association between exposure &
outcome there will be no difference between
the incidence rate , AR = 0
AR > 0, # of cases among exposed that could
be eliminated if the exposure is eliminated
Useful as a measure of the public health
impact of a particular exposure
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

To estimates the excess rate of disease in the


total study population of exposed &
unexposed individuals that is attributable to
the exposure
PAR = Ir I0
the rate of disease in the population (Ir) minus
the rate in the unexposed (I0)
PAR = (AR) (Pe)
alternatively, multiplying the attributable risk
(AR) by the proportion of exposed individuals
in the population (Pe)
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

PAR = Ir I0
= 104/2390 77/1908 = 316/105/year
PAR = (AR) (Pe)
= 1565/105 x (482/2390) = 316/105/year

Thus, if OC use were stopped, the excess


annual incidence of bacteriuria that could be
eliminated among women in this study is
316 per 100,000
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

PAR = Ir I0
= 104/2390 77/1908 = 316/105/year
PAR = (AR) (Pe)
= 1565/105 x (482/2390) = 316/105/year
Thus, if OC use were stopped, the excess
annual incidence of bacteriuria that could be
eliminated among women in this study is
316 per 100,000
PAR %

= PAR/ Ir x 100
= 316/4351.5 x 100
= 7.3 %
Thus, if OC use causes bacteria, about 7%
of all bacteriuria in the study population
could be prevented if OC use were
eliminated
Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D

Attributable risk
provides a measure of the public health
impact of an exposure, assuming the
association is one of a cause and effect
The magnitude of RR alone does not predict
the magnitude of the AR

Prepared by.Putri Eyanoer,MD.,Ms.Epi.,Ph.D