Risk Analysis

Lecture Handouts
St. Luke’s College of Nursing
SY. 2017 - 2018
 Health Risk

The probability that a person will develop

the disease or health related event within
a specified period of time
 Risk Factors
An aspect of:
– personal behavior or lifestyle
– environmental exposure, or
– inborn or inherited characteristic
associated with an increased occurrence of
disease or other health-related event or
condition.
Source: CDC, principles of Epidemiology, 2nd ed.
 Risk Factors
Risk factors increase the probability of getting
the disease or condition, but that doesn’t mean
risk factors will proceed to disease at all times
Population at Risk
(with Risk Factors)
T
I
M
E
(-) (+)
Disease Disease
 Risk Factors

Can be…
/ŶƚƌŝŶƐŝĐto an džƚƌŝŶƐŝĐto an
individual individual

e.g. genetic disposition e.g. microbial exposure

age chemical exposure
practices working conditions
 Population at Risk
Group of individuals whom has the high
chances of getting a certain disease
 Population at Risk: Examples
Urinary Tract Infection Gender: F

Parkinson’s Disease Age Group: Elderly

Malnutrition SES: Lower class

STD / HIV Occupation: Sex

worker

Diabetes Mellitus Lifestyle: Sedentary

 Cohort
A group of people who share a common
experience during a defined time period

Party College

Farmers
 Cohort
Cohorts proceed from common etiological
agent (risk factor) to a specific disease
outcome
Cause Effect
Etiological Agent Disease Outcome

Alcohol HĞĂĚĂĐŚĞ

Studying SƚƌĞƐƐ

Sun Exposure ^ŬŝŶĐancer

 Risk Analysis

Measures the probability of disease

occurrence due to a present risk factor by
comparing the groups which are exposed
and unexposed to the risk factor

Used for incidence measure

 Risk Analysis

One simple way to measure risk is to use a

probability value by means of a 2x2 contingency
table

Disease No Disease Total

Risk Factor Present
A B A +B
(exposed group)
Risk Factor Absent
C D C+D
(unexposed group)
Total A+C B+D A+B+C+D
 Risk Analysis
Example Cohort: Infants
Risk Factor: Gender (female)
Disease: UTI
Table 1. Number of UTI cases by gender a year after birth, Brgy. San Rafael,
Rodriguez, 2015
UTI No UTI Total
Being a Female
289 32 321
(exposed group)
Being a Male
21 200 221
(unexposed group)
Total 310 232 542
 Risk Analysis
Example Cohort: Infants
Risk Factor: Gender (female)
Disease: UTI

Females Males

289 32
Without
200
Without
21
UTI
UTI UTI UTI
 Risk Analysis Measures
Cumulative Incidence among exposed (CI1)
=A (A + B)

Cumulative Incidence among unexposed (CI0)

=C (C + D)

Attributable Risk (AR) = CI1 - CI0

Relative Risk (RR) = CI1 CI0

Odds Ratio (OR) = (A C) (B D)

Cumulative Incidence (Exposed)
Formula: CI1 = A
A + B

Incidence of the disease among the

exposed group

Example: exposed group (being a female)

Cumulative Incidence (Exposed)
Formula: CI1 = A
A + B

CI1 = 289 = 0.900 or 90%

321

Interpretation:
“Among the female infants, 90%
developed UTI after 1 year.”
 Cumulative Incidence (Unexposed)

Formula: CI0 = C
C + D

Incidence of the disease among the

unexposed group

Example: unexposed group (being a male)

 Cumulative Incidence (Unexposed)

Formula: CI0 = C
C + D

CI0 = 21 = 0.095 or 9.5%

221

Interpretation:
“Among the male infants, 9.5%
developed UTI after 1 year.”
 Relative Risk
Formula: RR = CI1
CI0
Also known as risk ratio

Measures the strength of association of the risk

factor and the disease outcome

Example: Risk Factor: Gender (being a female)

Disease Outcome: Urinary Tract Infection
 Relative Risk
Formula: RR = CI1
CI0
RR = 0.900 = 9.47
0.095

Interpretation:
“The 1 year risk of UTI among female infants
is almost nine and a half times higher than
that of male infants.”
 Attributable Risk
Formula: AR = CI1 - CI0

The difference between the rates of the 2

groups being compared

Example: Female CI1 = 0.900

Male CI0 = 0.095
 Attributable Risk
Formula: AR = CI1 - CI0

AR = 0.900 - 0.095 = 0.805 or 8/10

Interpretation:
“8 UTI cases developed out of 10 infants
due to being a female.”
 Odds Ratio

Formula: OR = A C
B D
Also known as relative odds

Measures the risk found from the ratio of

the odds for the exposed group to the
odds for the unexposed group.
 Odds Ratio
Formula: OR = A C
B D
OR = 289 21 = 13.76 = 86
32 200 0.16

Interpretation:
“Female infants are 86 times more likely
to develop UTI than male infants.”
 Risk Analysis
Example Cohort: SLMC Nurses
Risk Factor: Occupation (stress)
Disease: Obesity
Table 2. Number of Obese Nurses by level of stress management after 3
years of employment in SLMC, midyear 2013 to midyear 2016.
Obese Normal Total
Poor Stress Mngt.
31 9 40
(exposed group)
Good Stress Mngt.
12 48 60
(unexposed group)
Total 43 57 100
 Risk Analysis
Example Cohort: SLMC Nurses
Risk Factor: Occupation (stress)
Disease: Obesity

Poor Good

31 9
Normal
12
Obese
48
Normal
Obese
Cumulative Incidence (Exposed)
Formula: CI1 = A
A + B

CI1 = 31 = 0.775 or 77.5%

40

Interpretation:
“After 3 years, 77.5% of SLMC Nurses with
Poor Stress Management became obese.”
 Cumulative Incidence (Unexposed)

Formula: CI0 = C
C + D

CI0 = 12 = 0.2 or 20%

60

Interpretation:
“After 3 years, 20% of SLMC Nurses with
Good Stress Management became obese.”
 Relative Risk
Formula: RR = CI1
CI0
RR = 0.775 = 3.875
0.2

Interpretation:
“SLMC Nurses with Poor Stress Management is
nearly 4 times at risk of becoming obese after 3
years compared to those who have Good Stress
Management.”
 Attributable Risk
Formula: AR = CI1 - CI0

AR = 0.775 - 0.2 = 0.575 or 6/10

Interpretation:
“Out of 10 SLMC Nurses, 6 are
becoming obese because of Poor Stress
Management.”
 Odds Ratio
Formula: OR = A C
B D
OR = 31 12 = 2.5833 = 13.78
9 48 0.1875

Interpretation:
“Risk of obesity for SLMC Nurses with Poor
Stress Management is 14 times more
likely to develop than those with Good
Stress Management.”
 Risk Analysis
Protective Factor

It is the increase of the probability of

preventing the disease or condition.
 Risk Analysis
Example Cohort: Pregnancy
Risk Factor: Prenatal Visit (Complete)
Condition: Death
Table 3. Annual Maternal Death record of Brgy. Kalinga according to the
completion of Pre-natal visits, year 2015.
Death Alive Total
Completed Prenatal
3 55 58
(exposed group)
No Prenatal Visit
67 15 82
(unexposed group)
Total 70 70 140
Cumulative Incidence (Exposed)
Formula: CI1 = A
A + B

CI1 = 3 = 0.052 or 5.2%

58

Interpretation:
“Yearly death rate of mothers who
completed their prenatal visits is 5.2%.”
 Cumulative Incidence (Unexposed)

Formula: CI0 = C
C + D

CI0 = 67 = 0.817 or 81.70%

82

Interpretation:
“Yearly death rate of mothers who did not
visit the clinic for a prenatal check up is
81.70%.”
 Relative Risk
Formula: RR = CI1
CI0
RR = 0.052 = 0.0636
0.817
*Get the inverse = 1 = 15.7
0.636
Interpretation:
“The 1 year chances of staying alive is almost sixteen
times higher assurance for mothers who completed
their prenatal check-up compared to those who did
not seek Prenatal checkup.”
 Attributable Risk
Formula: AR = CI1 - CI0

AR = 0.052 - 0.817 = - 0.765 or 77/100

*remove the negative sign

Interpretation:
“Out of 100 mothers, 77 are prevented
from dying because of completed
prenatal visits.”
 Odds Ratio
Formula: OR = A C
B D
OR = 3 67 = 0.045 = 0.122
55 15 3.667
*Get the inverse = 1 = 8.14
0.1227
Interpretation:
“Mothers who completed prenatal visits are 8.14
times more likely to live than those who did not
bother to seek prenatal check-up.”
 Other References
Lecture presentation on Summarizing and Presenting
Vital Statistics and Health Parameters for Biostatistics by
H. Ho, 2010.

Lecture notes on Basic Concepts in Epidemiology for

Epidemiology 201 by P.A. Pinlac, 2014.

Lecture notes on Cohort Studies for Epidemiology 201 by

O.P. Saniel, 2014.