RRR (Relative risk reduction)
• Relative risk reduction (RRR) tells you by how much the treatment reduced the risk of
bad outcomes relative to the control group that did not have the treatment.
• For instance, supposing that a well-designed randomized controlled trial in children with
a particular disease found that 20 percent of the control group developed bad outcomes,
compared with only 12 percent of those receiving treatment. Thus, RR is 0.6 (12 percent
÷ 20 percent = 0.6).
• The relative risk reduction of fever and rash in the group of children on the intervention
was 40 per cent (1 – 0.6 = 0.4 or 40 per cent).
Problem set: OR, RR, IR, PR, CIR, IDR, AR, DSMR, CFR
1. A study on Tuberculosis (TB) infection in Dar es Salaam, Tanzania began in March 2015.
One of the districts in Dar es Salaam, Kinondoni, was monitored for new cases of TB and
TB-related deaths for a whole year. The entire adult population of Kinondoni was enrolled in
the study. A public health information campaign on TB took place in the district. Assume that
once a person gets infected with TB, they remain infected for the duration of the study.
The adult population of Kinondoni was 20,000 in March 2015. On 1st March, all inhabitants
were screened by the research team, and 1,000 were found to be infected with TB. On 1st
June, an additional 500 people were diagnosed with TB. On 1st September, 200 of the TB-
positive individuals diagnosed in March died. On 1st December, 2,000 adults arrived from a
neighboring city and settled in Kinondoni. They were all tested on the day of their arrival,
and 600 of them were TB-positive. On 28th February (the following year), 800 of the original
inhabitants of Kinondoni were newly diagnosed with TB.
i. What was the prevalence of TB infection in Kinondoni on 28th February?
[Link] was the 6-month cumulative incidence (incidence proportion) of TB infection in
the district from 1st March to 1st September?
iii. What was the incidence rate of TB infection in the district during the entire year?
2. A study was conducted to assess the relationship between smoking and the development of
lung cancer over 5 years. The study followed 10,000 individuals, dividing them into two
groups: smokers and non-smokers. At the end of the study, the number of individuals who
developed lung cancer in each group was recorded. Among smokers, (5,000 individuals)
200 individuals developed lung cancer. Among the non-smokers (5,000 individuals), only 50
individuals developed lung cancer.
i. What type of study is this?
[Link] a 2x2 table summarizing the data provided above for smokers and non-smokers
with respect to lung cancer development.
iii. Calculate the Relative Risk (RR) of developing lung cancer for smokers
compared to non-smokers.
iv. Calculate the Odds Ratio (OR) of developing lung cancer for smokers compared
to non-smokers.
v. Calculate the Relative Risk Reduction (RRR) associated with not smoking.
vi. Interpret the results.
3. In a case-control study examining the relationship between physical inactivity and the risk of
developing Type 2 diabetes, researchers gathered data from selected participants. The
study classified participants based on their activity levels and whether they developed
diabetes: 80 individuals reported being physically inactive (sedentary) among the cases
(Type 2 diabetes), whereas 50 individuals reported being physically inactive among the
controls (no diabetes). The number of people who were physically active in the control group
was 50, while among the cases, 20 individuals reported being physically active. Construct a
2x2 table, calculate the odds ratio (OR) for the association between physical inactivity and
the development of Type 2 diabetes. Interpret the result.
4. In a certain noisy factory, workers are given earplugs and are expected to wear them. An
industrial hygienist inspecting the plant found that 100 of the 500 workers in the factory were
not wearing the earplugs because they regarded them as uncomfortable and a nuisance. When
all the workers were given a hearing test, it was found that 16 of the earplug wearers and 40
of the non-wearers had developed significant hearing loss. All had had normal hearing at
their pre-employment exams 1 year earlier, when the plant opened.
a. Set up a two-by-two table for the association of earplug use and hearing loss.
b. Calculate a measure of relative risk (RR) of significant hearing loss in ear plug non-
wearers as compared to ear plug wearers.
c. Interpret the relative risk you calculated in question b.
5. b) The results of a 10-year cohort study of smoking and coronary heart disease (CHD)
among 8,000 adults show that the incidence of CHD among smokers was 84/3,000 and the
incidence among nonsmokers was 87/5,000.
a. Calculate the incidence of CHD in smokers that can be attributed to smoking.
b. Calculate the proportion of the total incidence of CHD in smokers that is attributable
to smoking.
c. Calculate the population attributable risk (PAR) due to smoking.
6. In an Asian country with a population of 6 million people, 60,000 deaths occurred during the
year ending December 31, 2010. These included 30,000 deaths from cholera in 100,000
people who were sick with cholera.
a. What was the cause-specific mortality rate from cholera in 2010?
b. What was the case-fatality from cholera in 2010?
7. A research team conducts a case-control study to investigate the possible link between
dietary habits and migraine occurrence in university students. They enrolled 480 participants:
160 students who experienced migraines during the last semester (cases), and 320 students
without any history of migraines (controls). The researchers collect data on whether students
typically consume at least one serving of green vegetables per day. Among those who had
migraines, 28 reported daily consumption of green vegetables, while 132 did not. Among
those without migraines, 128 reported daily consumption of green vegetables, while 192 did
not.
Construct a 2x2 table summarizing the exposure (daily green vegetable consumption) and
outcome (migraines).
Calculate the odds ratio (OR) for the association between green vegetable consumption
and migraine occurrence.
Interpret the result.
8. Results of a sore throat outbreak investigation are presented in the following tables. The first
table shows the total number of persons who ate each of two specified food items that were
possibly infective with group A streptococci. The second table shows the number of sick
persons (with acute sore throat) who ate each of the various specified combinations of the
food items. Calculate the sore throat attack rate in persons who ate both egg salad and tuna.
Table 1: Total number of persons who ate each specified combination of food
items
Ate tuna Did not eat tuna
Ate egg salad 75 100
Did not eat egg salad 200 50
Table 2: Total number of persons who ate a specified combination of food items
and who later developed a sore throat (got infected with group A streptococci)
Ate tuna Did not eat tuna
Ate egg salad 60 75
Did not eat egg salad 70 15