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Prevalence ratio and risk ratio #226

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Lidya1888 asked this question in Q&A
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In the case of probabilistic sampling in a cross-sectional study, can the prevalence ratio be interpreted as a risk ratio?

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@Lidya1888 good question. It depends on the context, but probably, no. Generally in epidemiology, risk means the probability of something bad happening during some time interval. Here's a definition in Modern Epi 4e (p57):

image

(see also https://en.wikipedia.org/wiki/Risk).

In a cross-sectional study, there's usually no time interval, and you can't measure incidence/risk, only prevalence, unless you're making some strong assumptions and/or using data fusion. Do you have a particular use case in mind?

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Thank you! In the note, it mentions that if a cross-sectional study is a probability sample of a population (which it rarely is), then we can estimate risks. So, is the note specifically referring to acute and short-lived diseases, and not all types of diseases even if the sampling is probabilistic?

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@Lidya1888 are you referring to https://d-morrison.github.io/rme/logistic-regression.html#odds-ratios-in-cross-sectional-studies ?

Using the word "risk" in that section was probably not ideal. I'll change it to "prevalence": https://github.com/d-morrison/rme/pull/229/files.

"Risk" sometimes gets used to mean the probability of having an ongoing infection at a given time point (in other words, prevalence), but usually it refers to the probability of a new infection during a given time period (i.e., the cumulative incidence proportion).

Under some assumptions, there is a relationship between incidence, prevalence, and duration of disease, as you alluded to (see section "Prevalence, Incidence, and Mean Duration" in Modern Epi 4, p. 73-74, for more details), but generally, when analyzing cross-sectional studies, I would recommend avoiding the term "risk".

Does that help at all?

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@Lidya1888 are you referring to https://d-morrison.github.io/rme/logistic-regression.html#odds-ratios-in-cross-sectional-studies ?

Using the word "risk" in that section was probably not ideal. I'll change it to "prevalence": https://github.com/d-morrison/rme/pull/229/files.

"Risk" sometimes gets used to mean the probability of having an ongoing infection at a given time point (in other words, prevalence), but usually it refers to the probability of a new infection during a given time period (i.e., the cumulative incidence proportion).

Under some assumptions, there is a relationship between incidence, prevalence, and duration of disease, as you alluded to (see section "Prevalence, Incidence, and Mean Duration" in Modern Epi 4, p. 73-74, for more details), but generally, when analyzing cross-sectional studies, I would recommend avoiding the term "risk".

Does that help at all?

@Lidya1888 PS - maybe this excerpt from https://en.wikipedia.org/wiki/Cross-sectional_study will help more:

Cross-sectional studies are descriptive studies (neither longitudinal nor experimental). Unlike case-control studies, they can be used to describe, not only the odds ratio, but also absolute risks and relative risks from prevalences (sometimes called prevalence risk ratio, or PRR).

See also Lee, James (1994). "Odds Ratio or Relative Risk for Cross-Sectional Data?". International Journal of Epidemiology. 23 (1): 201–3. doi:10.1093/ije/23.1.201. PMID 8194918.

I think "prevalence risk ratios" is a good word choice for cross-sectional studies.

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Yes I was referring to that section. Thank you, the explanation is clear and is indeed helpful.

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