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Statistics in Medicine: Calculating confidence intervals for relative risks (odds ratios) and standardised ratios and rates

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Morris, J. A, Gardner, M. J·1988·BMJ

Abstract

Gardner and Alunan explained the rationale for using estimation and confidence intervals in making inferences from analytical studies and described their calculation for means or proportions and their differences.1 In this paper we present methods for calculating confidence intervals for other common statistics obtained from medical investigations. The techniques for obtaining confidence intervals for estimates of relative risk are described. These can come either from an incidence study, where, for example, the frequency of a congenital malformation at birth is compared in two defined groups of mothers, or from a case-control study, where a group of patients with the disease of interest (the cases) is compared with another group of people without the disease (the controls). The methods of obtaining confidence intervals for standardised disease ratios and rates in studies of incidence, prevalence, and mortality are described. Such rates and ratios are commonly calculated to enable appropriate comparisons to be made between study groups after adjustment for confounding factors like age and sex. The most frequently used standardised indices are the standardised incidence ratio (SIR) and the standardised mortality ratio (SMR). A worked example is included for each method. The calculations have been carried out to full arithmetical precision, as is recom? mended practice,2 although intermediate steps are shown as rounded results. Some of the methods given in this paper are large sample approximations and are not reliable for studies with fewer than about 20 cases. Appropriate design principles for these types of study have to be adhered to since confidence intervals convey only the effects of sampling variation on the precision of the estimated statistics and cannot control for other errors such as biases due to the selection of inappropriate controls or in the methods of collecting the data.

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Research works printed but not linked: 18

  1. I Gardner MJ, Altman DG. Confidence intervals rather than P values: estimation rather than hypothesis testing. Br MedJ7 1986;292:746-50.
  2. Altman DG, Gore SM, Gardner MJ, Pocock SJ. Statistical guidelines for contributors to medical journals. BrMedJ 1983;286:1489-93.
  3. Katz D, Baptista J, Azen SP, Pike MC. Obtaining confidence intervals for the risk ratio in cohort studies. Biometrics 1978;34:469-74. · DOI · Paper page
  4. Miller E, Nicoll A, Rousseau SA, et al. Congenital rubella in babies of south Asian women in England and Wales: an excess and its causes. BrMedJ7 1987;294:737-9.
  5. Armitage P, Berry G. Statistical methods in medical research. 2nd ed. Oxford: Blackwell, 1987: 456-9.
  6. Woolf B. On estimating the relationship between blood group and disease. Ann Hum Genet 1955;19:251-3. · DOI · Paper page
  7. Shinebaum R, Blackwell CC, Forster PJG, Hurst NP, Weir DM, Nuki G. Non-secretion ofABO blood group antigens as a host susceptibility factor in the spondyloarthropathies. Br Med J 1987;294:208-10. · doi:10.1136/bmj.294.6566.208
  8. Eason J, Markowe HLJ. Controlled investigation of deaths from asthma in hospitals in the North East Thames region. BrMedJ 1987;294:1255-8.
  9. Breslow NE, Day NE. Statistical methods in cancer research. Vol 2. The analysis of cohort studies. Oxford: University Press, 1988.
  10. Roman E, Beral V, Carpenter L, et al. Childhood leukaemia in the West Berkshire and the Basingstoke and North Hampshire District Health Authorities in relation to nuclear establishments in the vicinity. BrMedJ 1987;294:597-602.
  11. Ederer F, Mantel N. Confidence lirnits on the ratio of two Poisson variables. Am J Epidemiol 1974;100: 165-7. · DOI
  12. Gardner MJ, Guyer PB, Barker DJP. Radiological prevalence of Paget's disease of bone in British migrants to Australia. BrMedJ 1978;i:1655-7.
  13. Barker DJP, Clough PWL, Guyer PB, Gardner MJ. Paget's disease of bone in 14 British towns. BrMedJ3 1977;i:1181-3.
  14. Clare AW. Hormones, behaviour and the menstrual cycle. I Psychosom Res 1985;29:225-33. · DOI
  15. Walsh RN, Budtz-Olsen I, Leader C, Cummins RA. The menstrual cycle, personality and academic performance. Arch Gen Psychiatry 1981;38:219-21. · DOI
  16. Slade P, Jenner FA. Performance tests in different phases of the menstrual cycle. J Psychosom Res 1980;24:5-8. · DOI
  17. Johansson G, Laakso ML, Karonen SL, Peder M. Examination stress affects plasma levels of TSH and thyroid hormones differently in females and males. Psychosom Med 1987;49:390-6. · DOI
  18. Massil HY, O'Brien PMS. Approach to the management of premenstrual syndrome. Clin Obstet Gynecol 1987;30:443-52. · doi:10.1097/00003081-198706000-00024

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Metadata

Authors
Morris, J. A., & Gardner, M. J.
Venue
BMJ
Publisher
BMJ
Published
1988-05-07
Volume
296
Issue
6632
Pages
1313-1316
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
OpenAlex
W2058055588
Cited by
764
References
0
FWCI
36.83
Type
journal article
Language
en
Open access
bronze

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Morris, J. A., & Gardner, M. J. (1988). Statistics in Medicine: Calculating confidence intervals for relative risks (odds ratios) and standardised ratios and rates. BMJ. https://doi.org/10.1136/bmj.296.6632.1313

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