Scribd Logo
Upload

Welcome to Scribd!

  • 46 views

    Chapter 7: Effect Modification: A Short Introduction To Epidemiology

    Uploaded by

    Bonkii Yee
    This document discusses effect modification, also known as statistical interaction. It provides examples of how different groups may interpret interaction between smoking and asbestos exposure on lung cancer risk differently based on whether a relative risk or risk difference measure is used. An epidemiologist concludes that both additive and multiplicative models should be considered, and that independent and joint effects of factors are most important to report regardless of the interaction model.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Chapter 7: Effect Modification: A Short Introduction To Epidemiology

    Uploaded by

    Bonkii Yee
    46 views23 pages
    This document discusses effect modification, also known as statistical interaction. It provides examples of how different groups may interpret interaction between smoking and asbestos exposure on lung cancer risk differently based on whether a relative risk or risk difference measure is used. An epidemiologist concludes that both additive and multiplicative models should be considered, and that independent and joint effects of factors are most important to report regardless of the interaction model.

    Original Title

    Effect Modification

    Copyright

    © Attribution Non-Commercial (BY-NC)

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document discusses effect modification, also known as statistical interaction. It provides examples of how different groups may interpret interaction between smoking and asbestos exposure on lung cancer risk differently based on whether a relative risk or risk difference measure is used. An epidemiologist concludes that both additive and multiplicative models should be considered, and that independent and joint effects of factors are most important to report regardless of the interaction model.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    46 views23 pages

    Chapter 7: Effect Modification: A Short Introduction To Epidemiology

    Uploaded by

    Bonkii Yee
    This document discusses effect modification, also known as statistical interaction. It provides examples of how different groups may interpret interaction between smoking and asbestos exposure on lung cancer risk differently based on whether a relative risk or risk difference measure is used. An epidemiologist concludes that both additive and multiplicative models should be considered, and that independent and joint effects of factors are most important to report regardless of the interaction model.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 23

    A short introduction to epidemiology

    Chapter 7: Effect Modification

    Neil Pearce Centre for Public Health Research Massey University Wellington, New Zealand

    Chapter 8

    Effect modification
    Concepts of interaction Multiplicative and additive
    models

    Effect Modification
    Occurs when the effect measure depends
    on the level of another factor Also known as statistical interaction

    Interaction (Effect Modification)


    Suppose we wish to study whether a particular
    factor (e.g. smoking) can cause a particular disease (e.g. lung cancer) Suppose there is another factor (e.g. asbestos exposure) which may also cause the disease and/or modify the effect of the main exposure of interest (i.e. smoking) We ask the question Does the effect of smoking (on lung cancer risk) depend on whether or not there has been exposure to asbestos?

    Asbestos Exposure, Smoking and Lung Cancer Risk


    Exposed to asbestos 35/1000 5/1000 Not exposed to asbestos 10/1000 1/1000

    Smokers Non-smokers

    Rate difference Rate ratio

    30/1000 7.0

    9/1000 10.0

    Biostatistician 1
    The relative risk (for smoking as a cause of lung
    cancer) is 10.0 in the general population, but only 7.0 in asbestos workers There is a negative effect modification in that the effect of smoking (on lung cancer) is lower in asbestos workers

    Biostatistician 2
    The risk difference (for smoking as a cause of
    lung cancer) is 9/1000 in the general population, but is 30/1000 in asbestos workers There is a positive effect modification in that the effect of smoking (on lung cancer) is higher in asbestos workers

    A lawyer
    The probability of causation (of smoking as a
    cause of lung cancer in a client who is suing the tobacco companies) is 9/10 (90%) in the general population, but is 30/35 (86%) in asbestos workers There is a negative effect modification in that the probability of causation of smoking (as a cause of lung cancer) is lower in asbestos workers

    A clinician
    The reduction in individual risk (of lung cancer)
    that could be achieved by a patient stopping smoking is 9/1000 in the general population, but is 30/1000 in asbestos workers There is a positive effect modification in that the individual risk from smoking (as a cause of lung cancer in an individual patient) is higher in asbestos workers

    A public health worker


    The number of deaths (from lung cancer) that
    could be prevented by preventing smoking is 9 per 1000 in the general population, but is 30 per 1000 in asbestos workers There is a positive effect modification in that the potential number of deaths (from lung cancer) prevented by preventing smoking is higher in asbestos workers

    An epidemiologist
    Background

    1/1000

    An epidemiologist
    Background Asbestos only

    1/1000

    4/1000

    An epidemiologist
    Background Smoking only

    1/1000

    9/1000

    An epidemiologist
    Background Asbestos only Smoking only Both

    A U

    1/000 1/35 (3%)

    4/1000 4/35 (11%)

    9/1000 9/35 (26%)

    21/1000 21/35 (60%)

    An epidemiologist
    In the group exposed to both factors: 1 case (3%) occurred through unknown background exposures (U) 4 cases (11%) through mechanisms involving asbestos exposure (A) alone (and not smoking) together with unknown background exposures (U) 9 cases (26%) occurred through mechanisms involving smoking (S) alone (and not asbestos) together with unknown background exposures (U) 21 cases (60%) occurred through mechanisms involving both factors (A+S) together with unknown background exposures (U)

    Interaction (Effect Modification)


    Do factor S and factor A interact? Does the effect of S (in causing disease Y)
    depend on whether or not A is present? The answer to the latter question depends on what we mean by the word effect This word has different meanings for biostatisticians, public health workers, physicians, biologists and epidemiologists

    Chapter 8

    Effect modification
    Concepts of interaction Multiplicative and additive
    models

    Interaction (Effect Modification)


    In most perspectives (and particularly from
    the viewpoint of epidemiology and public health), two factors (A and B) are considered to be independent if their effects are additive, and they are considered to interact if their joint effect is different from the sum of their independent effects.

    Interaction (Effect Modification)


    Interaction should be assessed in terms of a
    departure from additive effects (this requires an additive model, i.e. a risk difference measure) There are several reasons why it is generally preferable to use a multiplicative model (i.e. a relative risk measure)

    Interaction (Effect Modification)


    When studying the interaction of factors A
    and B, we can use a relative risk model (adjusting for all other potential confounders), but present the independent and joint effects of factors A and B

    Issues in Interaction
    Additive and multiplicative models are not the
    only options Under most biological models, factors which are part of the same causal process have joint effects which are more than additive Should we test for interaction?

    Issues in Interaction
    Most studies are consistent with both additive
    and multiplicative models and tests for interaction have low statistical power Whatever pattern the data follows, we can get all the information we need simply by calculating the independent and joint effects of the factors being considered

    A short introduction to epidemiology

    Chapter 8: Effect Modification

    Neil Pearce Centre for Public Health Research Massey University Wellington, New Zealand

    You might also like