4.7 Problems

Problem 4.7.1. In a cohort study, \(32\) of \(400\) exposed and \(18\) of \(600\) unexposed people develop the disease. Estimate the risk ratio, the risk difference and the odds ratio, each with a \(95\%\) confidence interval.

Show solution

Solution. \(\hat p_1 = 0.08\) and \(\hat p_0 = 0.03\). \(\widehat {\RR } = 2.67\), with \[ \text {SE}(\log \widehat {\RR }) = \sqrt {1/32 - 1/400 + 1/18 - 1/600} = 0.287 \] and interval \((1.52,\ 4.68)\). \(\widehat {\RD } = 0.050\), with \[ \text {SE}(\widehat {\RD }) = \sqrt {0.08 \times 0.92/400 + 0.03 \times 0.97/600} = 0.0152 \] and interval \((0.020,\ 0.080)\). \(\widehat {\OR } = (32 \times 582)/(18 \times 368) = 2.81\), with \[ \text {SE}(\log \widehat {\OR }) = \sqrt {1/32 + 1/18 + 1/368 + 1/582} = 0.302 \] and interval \((1.56,\ 5.08)\).

Problem 4.7.2. Show that the odds ratio for remaining free of disease is \(1/\OR \). Find the risk ratio for remaining free of disease when \(p_1 = 0.2\) and \(p_0 = 0.1\), and compare it with \(1/\RR \).

Show solution

Solution. The odds of remaining free are \((1 - p_i)/p_i\), the reciprocal of the disease odds, so their ratio is the reciprocal of \(\OR \). With \(p_1 = 0.2\) and \(p_0 = 0.1\), \(\RR = 2\) but the risk ratio for remaining free is \(0.8/0.9 = 0.889\), not \(0.5\). The same data are a doubling of the risk of disease and an \(11\%\) reduction in the chance of staying well. The risk ratio depends on which outcome is called the event; the odds ratio does not (\(2.25\) one way, \(1/2.25\) the other).

Problem 4.7.3. A case-control study finds no exposed cases among \(6\) cases and \(20\) exposed among \(60\) controls, so the table is \(a = 0\), \(b = 6\), \(c = 20\), \(d = 40\). Compute the odds ratio and its Woolf interval after adding \(\tfrac 12\) to every cell. What does the interval say?

Show solution

Solution. With the correction, \(\widehat {\OR } = (0.5 \times 40.5)/(6.5 \times 20.5) = 0.152\) and \(\text {SE}(\log \widehat {\OR }) = \sqrt {2 + 1/6.5 + 1/20.5 + 1/40.5} = 1.49\), so the interval is \(0.152\,e^{\pm 2.92} = (0.008,\ 2.8)\). The point estimate suggests strong protection, but the interval includes values well above \(1\): six cases cannot distinguish a protective exposure from a moderately harmful one. The point estimate depends strongly on the arbitrary \(\tfrac 12\) and should not be reported alone.

Problem 4.7.4. In a population, exposed people contribute \(20{,}000\) person-years at risk with an incidence rate of \(6\) per \(1000\), and unexposed people \(80{,}000\) person-years with \(2\) per \(1000\). A density-sampled case-control study takes all cases and four controls per case. Find the expected table and its odds ratio.

Show solution

Solution. Cases: \(120\) exposed and \(160\) unexposed, \(280\) in all. Controls: \(1120\), of whom a share \(20{,}000/100{,}000 = 0.2\) are exposed, so \(224\) exposed and \(896\) unexposed. The odds ratio is \((120 \times 896)/(160 \times 224) = 3.0 = 6/2\), the rate ratio, as Theorem 4.6.1 says.

Problem 4.7.5. In Example 4.4.3, verify \(P(a = 6 \mid m_1 = 8) = 0.0433\) from the hypergeometric formula, and find the mean and variance of \(a\) under no association.

Show solution

Solution. \(P(a = 6) = \binom {10}{6}\binom {12}{2}/\binom {22}{8} = 210 \times 66/319{,}770 = 13{,}860/319{,}770 = 0.0433\). The mean is \(n_1 m_1/n = 10 \times 8/22 = 3.64\) and the variance \(n_1 n_0 m_1 m_0/\{n^2(n - 1)\} = 10 \times 12 \times 8 \times 14/(484 \times 21) = 1.32\). The observed \(6\) is \((6 - 3.64)/\sqrt {1.32} = 2.05\) standard deviations above the mean.

Problem 4.7.6. In a case-cohort study, a random \(5\%\) of a cohort of \(20{,}000\) is sampled at the start as the subcohort; \(250\) of its \(1000\) members are exposed. Over ten years the cohort produces \(150\) exposed cases and \(200\) unexposed cases. Estimate the ten-year risk ratio. Why is the rare disease assumption not needed?

Show solution

Solution. The odds ratio of cases against the subcohort is \((150/200)/(250/750) = 2.25\). The subcohort’s exposure odds estimate \(N_1/N_0\), so the odds ratio estimates \[ \frac {A_1/A_0}{N_1/N_0} = \frac {A_1/N_1}{A_0/N_0} , \] the ten-year risk ratio. The controls represent the whole cohort at the start, including people who later become cases, so the comparison is between the cases and the people at risk at baseline, which is exactly what a risk ratio compares. No approximation is involved.

Questions on this section

Stuck on something here? Ask below and it stays attached to this topic.