Risk factor explained

In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection.^[1]

Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often used as a synonym. The main difference lies in the realm of practice: medicine (clinical practice) versus public health. As an example from clinical practice, low ingestion of dietary sources of vitamin C is a known risk factor for developing scurvy. Specific to public health policy, a determinant is a health risk that is general, abstract, related to inequalities, and difficult for an individual to control.^{[2] [3] [4]} For example, poverty is known to be a determinant of an individual's standard of health.

Risk factors may be used to identify high-risk people.

Correlation vs causation

Risk factors or determinants are correlational and not necessarily causal, because correlation does not prove causation. For example, being young cannot be said to cause measles, but young people have a higher rate of measles because they are less likely to have developed immunity during a previous epidemic. Statistical methods are frequently used to assess the strength of an association and to provide causal evidence, for example in the study of the link between smoking and lung cancer. Statistical analysis along with the biological sciences can establish that risk factors are causal. Some prefer the term risk factor to mean causal determinants of increased rates of disease, and for unproven links to be called possible risks, associations, etc.

When done thoughtfully and based on research, identification of risk factors can be a strategy for medical screening.^[5]

Terms of description

Mainly taken from risk factors for breast cancer, risk factors can be described in terms of, for example:

• Relative risk, such as "A woman is more than 100 times more likely to develop breast cancer in her 60s than in her 20s."^[6]
• Fraction of incidences occurring in the group having the property of or being exposed to the risk factor, such as "99% of breast cancer cases are diagnosed in women."^[7]
• Increase in incidence in the exposed group, such as "each daily alcoholic beverage increases the incidence of breast cancer by 11 cases per 1000 women."^[8]
• Hazard ratio, such as "an increase in both total and invasive breast cancers in women randomized to receive estrogen and progestin for an average of 5 years, with a hazard ratio of 1.24 compared to controls."^[9]

Example

At a wedding, 74 people ate the chicken and 22 of them were ill, while of the 35 people who had the fish or vegetarian meal only 2 were ill. Did the chicken make the people ill?

Risk = (numberofpersonsexperiencingevent(foodpoisoning))/(numberofpersonsexposedtoriskfactor(food))

So the chicken eaters' risk = 22/74 = 0.297
And non-chicken eaters' risk = 2/35 = 0.057.

Those who ate the chicken had a risk over five times as high as those who did not, that is, a relative risk of more than five. This suggests that eating chicken was the cause of the illness, but this is not proof.

This example of a risk factor is described in terms of the relative risk it confers, which is evaluated by comparing the risk of those exposed to the potential risk factor to those not exposed.

General determinants

The probability of an outcome usually depends on an interplay between multiple associated variables. When performing epidemiological studies to evaluate one or more determinants for a specific outcome, the other determinants may act as confounding factors, and need to be controlled for, e.g. by stratification. The potentially confounding determinants varies with what outcome is studied, but the following general confounders are common to most epidemiological associations, and are the determinants most commonly controlled for in epidemiological studies:

• Age (0 to 1.5 years for infants, 1.5 to 6 years for young children, etc.)
• Sex or gender (Male or female)^[10]
• Ethnicity (Based on race)

Other less commonly adjusted for possible confounders include:

• Social status/income
• Geographic location
• Genetic predisposition
• Gender identity
• Occupation
• Overwork^[11]
• Sexual orientation
• Level of chronic stress
• Diet
• Level of physical exercise
• Alcohol consumption and tobacco smoking
• Other social determinants of health

Risk marker

A risk marker is a variable that is quantitatively associated with a disease or other outcome, but direct alteration of the risk marker does not necessarily alter the risk of the outcome. For example, driving-while-intoxicated (DWI) history is a risk marker for pilots as epidemiologic studies indicate that pilots with a DWI history are significantly more likely than their counterparts without a DWI history to be involved in aviation crashes.^[12]

History

The term "risk factor" was coined by former Framingham Heart Study director, William B. Kannel in a 1961 article in Annals of Internal Medicine.^[13]

See also

• Health risk assessment
• High-risk people
• Protective factor
• Risk factor (finance)
• Social determinants of health

Further reading

• S. P. Case; K. R. Haines (2009). Understanding Youth Offending: Risk Factor Research, Policy and Practice. Willan. 2009. .

Notes and References

1. Book: Parritz, Robin Hornik. Disorders of childhood : development and psychopathology. Troy, Michael F. (Michael Francis). 9781337098113. Third. Boston, MA. 960031712. 2017-05-24.
2. Book: Improving Health in the Community: A Role for Performance Monitoring: 2. Understanding Health and Its Determinants: A Model of the Determinants of Health. National Academy of Sciences: National Academies Press: Institute of Medicine (US) Committee on Using Performance Monitoring to Improve Community Health. 1997. 978-0309055345. "Unlike a biomedical model that views health as the absence of disease, this dynamic framework includes functional capacity and well-being as health outcomes of interest. It also presents the behavioral and biologic responses of individuals as factors that influence health but are themselves influenced by social, physical, and genetic factors that are beyond the control of the individual.".
3. Web site: Health Impact Assessment (HIA): Glossary of terms used. World Health Organization. July 20, 2019.
4. Web site: Health Impact Assessment (HIA): The determinants of health. https://web.archive.org/web/20040530022104/http://www.who.int/hia/about/glos/en/. dead. May 30, 2004. World Health Organization. July 20, 2019.
5. Wald. N. J.. Hackshaw. A. K.. Frost. C. D.. When can a risk factor be used as a worthwhile screening test?. BMJ. 319. 7224. 1999. 1562–1565. 0959-8138. 10.1136/bmj.319.7224.1562. 1117271. 10591726.
6. Book: Margolese RG, Fisher B, Hortobagyi GN, Bloomer WD . Bast RC, Kufe DW, Pollock RE . Cancer Medicine . 5th . B. C. Decker . Hamilton, Ontario . 2000 . Neoplasms of the Breast . §Risk Factors . 1-55009-113-1 . https://www.ncbi.nlm.nih.gov/books/NBK20900/#A29677 . 27 January 2011 . etal.
7. Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN . Breast carcinoma in men: a population-based study . Cancer . 101 . 1 . 51–7 . July 2004 . 15221988 . 10.1002/cncr.20312. 972345 . free .
8. Allen NE, Beral V, Casabonne D, etal . Moderate alcohol intake and cancer incidence in women . Journal of the National Cancer Institute . 101 . 5 . 296–305 . March 2009 . 19244173 . 10.1093/jnci/djn514. free .
9. Heiss . G. . Wallace . R. . Anderson . G. L. . Aragaki . A. . Beresford . S. A. A. . Brzyski . R. . Chlebowski . R. T. . Gass . M. . Lacroix . A. . Health Risks and Benefits 3 Years After Stopping Randomized Treatment with Estrogen and Progestin . JAMA: The Journal of the American Medical Association . 299 . 9 . 1036–45 . 2008 . 10.1001/jama.299.9.1036 . 18319414. free .
10. Book: Mash, Eric J.. Abnormal child psychology. Wolfe, David A. (David Allen), 1951-. 2019. 9781337624268. Seventh. Boston, MA. 1022139949.
11. Pega . Frank . Nafradi . Balint. Momen . Natalie . Ujita . Yuka . Streicher . Kai . Prüss-Üstün . Annette . Technical Advisory Group . Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury . Environment International . 2021 . 154 . 106595 . 10.1016/j.envint.2021.106595. 8204267 . 0160-4120 . 34011457 . free .
12. Li G., Baker S. P., Qiang Y., Grabowski J. G., McCarthy M. L. Driving-while-intoxicated history as a risk marker for general aviation pilots. Accid Anal Prev. 2005;37(1):179-84./McFadden K. L. Driving while intoxicated (DWI) convictions and job-related flying performance – a study of commercial air safety. J Oper Res Soc. 1998;49:28–32
13. News: William Kannel, Former Director of the Framingham Heart Study, Dead at 87. Forbes . Larry . Husten . 23 August 2011.