SIMPLE ESTIMATION OF POPULATION ATTRIBUTABLE RISK FROM CASE-CONTROL STUDIES

1977 ◽  
Vol 106 (4) ◽  
pp. 260-260 ◽  
Author(s):  
JOHN W. TAYLOR
Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 16-17
Author(s):  
Abhay Singh

Background. Clonal hematopoiesis of indeterminate potential (CHIP) represents a precursor state of myeloid leukemogenesis. Several studies thus far have convincingly demonstrated that presence of CHIP is associated with increased risks of myeloid neoplasm (MN) development. These findings have important intrinsic utility; however, there has been lack of attempts to translate this knowledge into estimates of disease burden suitable for determining its potential at population level. Therefore, the aim of this analysis was to estimate the population attributable fraction (PAF) for MNs associated with CHIP using risk ratio estimates derived from pooled analysis of observational studies. Methods. Eligible studies were case-control (n=3) and cohort (n=3) studies with dichotomous outcome (MN or no MN) and the presence or absence of the risk factor (CHIP). Mantel-Haenszel method for calculating the weighted pooled odds ratio (OR) under the fixed effects model was used, using software RevMan 5.3. OR being the key statistic for case-control studies was the preferred risk estimate to measure association between CHIP and MN in the selected case-control studies. We used OR as risk estimate for cohort studies as well, since MN occurred in less than 10% of the CHIP negative population, and therefore, OR provided a reasonable approximation of the relative risk. From the pooled OR, estimate of population attributable risk% (PAR%) was calculated using the formula: 100*(Px*(OR-1))/(1+(Px*(OR-1))), where Px represented estimate of population exposure (proportion of CHIP positive cases in the population). Results. 23,983 participants with 345 MN cases in six studies were included in the pooled analyses (Figure 1). In the CHIP positive population, there were total 230 MN cases of the total 2304 participants. There were 115 MN cases in the CHIP negative population (n= 21,679). For all studies, the pooled OR for those with CHIP compared with those without was 5.45 (95% CI, 4.06-7.30) with low overall heterogeneity (I2=2%, Fig. 1). Estimate of population exposure (Px) was 0.088 (2074/23638). PAR% calculated using formula 100*(Px*(OR-1))/(1+(Px*(OR-1))), was 28.14%, suggesting that of all the MN cases, including those with or without CHIP, 28.14% could be attributed to CHIP. Conclusion. CHIP's strong association with myeloid neoplasm development was confirmed in this pooled analysis. Individuals with MN were 5.45 times more likely to be CHIP positive than those without MN. Further, in this analysis, we estimate population level contribution of CHIP to MN development. We estimate that 28% of MNs were attributable to positive CHIP status, thus representing 28% of the cases in the total population that can be prevented by intervening against the exposure- CHIP. Determining PAR% is an especially useful and often underutilized first step in designing public health interventions directed against harmful exposures. These findings also brings forth an important consideration, that CHIP though an important risk factor is not obligatory for MN development. Majority of MNs can not attributed to positive CHIP status. Therefore, importance of traditionally known risk factors such as smoking, chemotherapy and radiation exposure need appropriate quantification, especially as they can be entirely preventable and are established risk factors for CHIP positivity as well. Disclosures No relevant conflicts of interest to declare.


2019 ◽  
Vol 10 (2) ◽  
pp. 211-219
Author(s):  
Imelda Diana Marsilia

Program Jaminan Kesehatan  merupakan salah satu upaya dalam penurunan Angka Kematian Ibu (AKI)  di Indonesia. Cakupan persalinan oleh tenaga kesehatan di Indonesia masih di bawah target yang diharapkan, termasuk di Kecamatan Babakan Madang Kabupaten Bogor yang hanya mencapai 66,4 % tahun 2011.  Cakupan persalinan oleh dukun beranak peserta jaminan kesehatan di Puskesmas Babakan Madang  adalah 40% pada tahun 2011. Tujuan  penelitian ini untuk menganalisis faktor-faktor yang berhubungan dengan pemilihan dukun beranak sebagai penolong persalinan pada peserta jaminan kesehatan di wilayah kerja Puskesmas Babakan Madang Kabupaten Bogor. Metode  Penelitian ini merupakan penelitian analitik dengan pendekatan Case Control. Penelitian dilakukan terhadap 122 orang ibu bersalin pada periode Juli sampai dengan Desember  2012 dibagi dalam 2 kelompok 61 orang kelompok kasus (dukun beranak) dan 61 orang kelompok kontrol (bidan). Analisis data menggunakan uji  chi square  dan uji regresi logistik ganda dengan tingkat kemaknaan (p0,05), dan analisis PAR (population attributable risk).  Hasil penelitian menunjukkan faktor yang berhubungan  dengan pemilihan dukun beranak sebagai penolong persalinan  secara signifikan adalah pengetahuan ibu p=0,003, sikap p= 0,007, pendidikan ibu p= 0,001, Sosial Budaya p= 0,001, penghasilan keluarga p=0,001, dukungan suami p=0,018 sedangkan keterjangkauan layanan, umur, paritas, pekerjaan tidak berhubungan (p0,05). Faktor dominan yang berhubungan dengan keputusan memilih penolong persalinan berdasarkan analisis multivariabel adalah  sosial budaya (OR= 5,644  ;95%CI=  2,016-15,797).  Penelitian ini memberikan kesimpulan bahwa pengetahuan,  Sikap,  pendidikan ibu, sosial budaya penghasilan keluarga dan dukungan suami yang tidak mendukung memilih dukun beranak sebagai  penolong persalinan pada peserta jaminan kesehatan. Perlu dilakukan upaya peningkatan pengetahuan, pendidikan, dukungan suami dan sosial budaya yang mendukung serta pendidikan bidan gratis bagi anak dukun beranak.  Kata Kunci : Pemilihan penolong persalinan, Dukun beranak, Jaminan kesehatan


1985 ◽  
Vol 122 (5) ◽  
pp. 904-914 ◽  
Author(s):  
PAOLO BRUZZI ◽  
SYLVAN B. GREEN ◽  
DAVID P. BYAR ◽  
LOUISE A. BRINTON ◽  
CATHERINE SCHAIRER

Author(s):  
Mark Elwood

This chapter shows the format and derivation of results from studies. Cohort and intervention studies yield relative risk and risk difference, also known as attributable risk, and number needed to treat (NNT). Count and person-time methods are shown. Additive and multiplicative models for two or more exposures are shown. Case-control studies give primarily odds ratio; the relationship between this and relative risk is explained. Different sampling schemes for case-control studies include methods were a case can also be a control. Surveys yield results similar to cohort studies.


1996 ◽  
Vol 29 (1) ◽  
pp. 63-75 ◽  
Author(s):  
Maura Mezzetti ◽  
Monica Ferraroni ◽  
Adriano Decarli ◽  
Carlo La Vecchia ◽  
Jacques Benichou

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250034
Author(s):  
David L. Hahn

Background Chlamydia pneumoniae (Cp) is an obligate intracellular human respiratory pathogen producing persisting lung infection with a plausible link to asthma pathogenesis. The population attributable risk of potentially treatable Cp infection in asthma has not been reported. Methods The author searched from 2000 to 2020 inclusive for previously un-reviewed and new cross sectional and prospective controlled studies of Cp biomarkers and chronic asthma in both children and adults. Qualitative descriptive results and quantitative estimates of population attributable risk for selected biomarkers (specific IgG, IgA and IgE) are presented. Findings No large, long-term prospective population-based studies of Cp infection and asthma were identified. About half of case-control studies reported one or more significant associations of Cp biomarkers and chronic asthma. Heterogeneity of results by age group (pediatric v adult asthma), severity category (severe/uncontrolled, moderate/partly controlled, mild/controlled) and antibody isotype (specific IgG, IgA, IgE) were suggested by the qualitative results and confirmed by meta-analyses. The population attributable risks for Cp-specific IgG and IgA were nul in children and were 6% (95% confidence interval 2%-10%, p = 0.002) and 13% (9%-18%, p<0.00001) respectively in adults. In contrast to the nul or small population attributable risks for Cp-specific IgG and IgA, the population attributable risk for C. pneumoniae-specific IgE (children and adults combined) was 47% (39%-55%, p<0.00001). In the subset of studies that reported on asthma severity categories, Cp biomarkers were positively and significantly (P<0.00001) associated with asthma severity. Interpretation C. pneumoniae-specific IgE is strongly associated with asthma and asthma severity, suggesting a possible mechanism linking chronic Cp infection with asthma in a subset of individuals with asthma. Infection biomarkers should be included in future macrolide treatment trials for severe and uncontrolled asthma.


2017 ◽  
Vol 2 (2) ◽  
pp. 20
Author(s):  
Maria Ulfah ◽  
Bethy S. Hernowo ◽  
Farid Husin ◽  
Kusnandi Rusmil ◽  
Meita Dhamayanti ◽  
...  

Campak (measles) merupakan penyakit infeksi yang sangat menular dan salah satu Penyakit yang dapat dicegah dengan imunisasi (PD3I). Penyakit campak menjadi penyebab kematian pada Balita (bayi lima tahun). Jumlah kematian akibat campak pada Balita didunia sebanyak 158.000 kasus pertahun dan 95% dari kejadian penyakit campak tersebut berada di negara berkembang seperti Indonesia. Cakupan imunisasi campak di Jawa Barat sangat tinggi, namun kejadian penyakit campak pada Balita juga tinggi. Tujuan penelitian ini untuk menganalisis faktor-faktor yang berhubungan dengan kejadian penyakit campak pada Balita di Kecamatan Bekasi Timur Kota Bekasi. Penelitian ini merupakan penelitian analitik dengan pendekatan case control. Penelitian dilakukan terhadap 122 Balita pada periode Februari–April 2015, dibagi dalam 2 kelompok, 61 orang kelompok kasus (Balita dengan riwayat sakit campak) dan 61 orang kelompok kontrol (Balita sehat). Analisis data menggunakan uji kai kuadrat dan uji regresi logistik ganda dengan tingkat kemaknaan (p<0,05), dan analisis PAR (population attributable risk). Hasil penelitian menunjukkan faktor yang berhubungan secara signifikan adalah pendidikan ibu (p=0,000), pengetahuan ibu (p=0,000), sikap ibu (p=0,011), penghasilan (p=0,001), umur Balita saat imunisasi (p=0,000), status gizi Balita (p=0,000), ventilasi (p=0,002), pengetahuan tenaga medis (p=0,003), dan kelengkapan cold chain (p=0,000), sedangkan umur ibu, pekerjaan ibu, kepadatan hunian tidak berhubungan (p>0,05). Faktor dominan yang berhubungan dengan kejadian penyakit campak pada Balita berdasarkan analisis multivariabel adalah umur Balita saat imunisasi (OR = 9,492 ;95% CI = 3,017– 29,866). Simpulan faktor pendidikan ibu, faktor pengetahuan ibu, faktor sikap ibu, faktor penghasilan, faktor umur Balita saat imunisasi, faktor status gizi Balita, faktor ventilasi,  faktor pengetahuan tenaga medis dan faktor kelengkap an cold chain merupakan faktor yang memengaruhi terhadap kejadian campak, sedangkan faktor umur ibu, pekerjaan ibu dan kepadatan hunian tidak mendukung meningkatkan risiko terkena penyakit campak pada Balita. Perlu dilakukan upaya perbaikan terhadap faktor-faktor yang tidak mendukung terhadap keberhasilan imunisasi campak


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