Lm sng thng k 22

o lng nh hng:
Odds ratio, relative risk, risk ratio, hazard ratio
Nguyn Vn Tun

Trong bi Lm sng thng k 14, ti gii thch s lin h v khc bit gia
odds ratio (OR) v relative risk (RR), v nhng kh khn trong vic din gii OR. Gn
y c mt s bn hi ti v risk ratio v hazard ratio (HR) l g, v cch s dng cng
nh din gii cc ch s ny nh th no. Trong bi ny, ti s gii thch ngn gn cc
thut ng ny. Ti s khng dch sang ting Vit, v c cc bn c bit thut ng
nguyn thy ting Anh khi ra ngoi c dp hi nhp cng cc ng nghip quc t.
Nhng trc khi vo , ti mun k cho cc bn mt cu chuyn trong lch s y
khoa c lin quan n nguy c v xc sut. Christiaan Barnard l nh gii phu u tin
ghp tim (heart transplantation) trn th gii. Trong hi k ca mnh, ng thut li mt
cu chuyn v bnh nhn thay tim u tin trn th gii ca Barnard: l Louis
Washkansky. Khi c a vo phng gii phu, Washkansky ang say m c sch
trn ging nh khng g n mt s kin lch s y khoa sp xy ra. Barnard vo
phng gii phu, t gii thiu vi Washkansky, v gii thch tng tn rng ng s ct b
tri tim ca Washkansky v thay vo l mt tri tim mi lnh mnh hn. Barnard ni
thm: ng s c c may bnh phc (there is a chance that you can get back to normal life
again). Washkansky khng hi ci c may l bao nhiu, khng hi ng c th sng
bao lu na, m ch ni ti sn sng v quay li tip tc c sch! Barnard cm thy
rt lo u v bi ri, bi v Washkansky r rng khng thc c rng y l mt s
kin quan trng trong cuc i ca chnh ng m cn l mt s kin lch s trong y hc.
Nhng b v ca Washkansky hi: C may m bc s ni l bao nhiu? Barnard tr
li: 80 phn trm. Mi tm ngy sau cuc gii phu, Washkansky qua i. y,
con s 80% c hiu nh th no? C phi trong 100 ngi c phu thut th c 80
ngi sng st? Hay n phn nh mt tin tng, mt cm nhn c nhn ca bc s
Barnard? Phn di y s bn n ngha ca con s nguy c ny.

Khi nim nguy c v xc sut

Tt c nhng ch s va cp (RR, HR, OR) u c lin h n khi nim risk
(nguy c). Trong y khoa, nguy c l mt khi nim tng i, ni n xc sut ca mt
s kin c th xy ra trong mt thi gian nht nh. Do , c hai kha cnh trong nh
ngha trn: s kin v thi gian. S kin trong bi cnh nghin cu y khoa cp n
nhng bin c lm sng nh t vong, mc bnh, bnh ti pht, v.v Bi v nguy c c
yu t thi gian, cho nn thng thng chng ta ni n nguy c l phi km theo nguy
c trong mt qung thi gian nht nh. Nu khng c yu t thi gian, ngi ta c th
hiu l nguy c trn i (lifetime risk).

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Nguy c l mt xc sut. Xc sut, theo T in Ting Vit, l S o phn chc

ca mt bin c ngu nhin. nh ngha ny c ba phn: nh lng (s o), chc chn,
v ngu nhin. C g mu thun y: Chng ta c th ni mt hin tng xy ra do hai
yu t, ngu nhin v chc chn, ch kh m ni trong ngu nhin khng c s chc
chn! V th chng ta khng th dng nh ngha ph thng ny trong khoa hc c.
Trong ton hc, xc sut thng c gii thch bng mt v v v tr chi sc
sc hay mt ng xu. Mt ng tin (kim loi) c hai mt, v hy tm gi hai mt l
A v B. Nu chng ta gieo ng tin mt ln, kt qu s l: hoc A xut hin, hoc B
xut hin. Nu chng ta gieo nhiu ln (hng triu ln chng hn), chng ta s k vng
mt A s xut hin khong 50 phn trm. Theo mt nh ngha ca ton hc, xc sut
mt A xut hin l 0.5 hay 50%. Chng ta cng c th ni xc sut B xut hin l 50%.
Nhng l mt v d tng i v b (rt hay thy trong sch gio khoa thng
k) chng c gi tr ng dng g trong thc t. Chng ta c th t v d xc sut
trong mi trng x hi v y t mt cch thc t hn. V d trong mt cng ng c dn
gm 1000 ngi, c 20 ngi b bnh ung th. y s ngi c tim nng b ung th
l 1000 ngi, v s ngi thc s b ung th (s kin) l 20 ngi. Chng ta c vi
cch pht biu v qui m ny:

Cch th nht l dng con s phn trm: T l bnh ung th trong cng
ng l 2 phn trm (ly 20 chia cho 1000, ri ly kt qu nhn cho 100).

Cch th hai l n gin ly 20 chia cho 1000 v vi kt qu 0.02, chng

ta cng c th pht biu Xc sut b bnh ung th trong cng ng l
0.02. Chng ta cng c th th hin pht biu bng mt k hiu ton
hc: P(ung th) = 0.02. (P l vit tt ca ch probability, tc xc sut).

Cch th ba l dng t s kh d (likelihood ratio) bng cch ly s ngi

b ung th chia cho s ngi khng b ung th: 20 / 980 = 0.082 (t s kh
d b ung th l 0.082). T s kh d cng cao, xc sut b ung th cng
cao. (Ch : nu t s ny l 1, iu c ngha l xc sut b ung th l
0.5).

Nh vy, xc sut l t l tn s mt s kin xy ra. l mt nh ngha xc

sut c in theo trng phi ting Anh gi l frequentist probability (tn s xc sut).
Nhng cch nh ngha da vo tn s nh th, d rt thng dng trong sch gio khoa v
ton hc v thng k xc sut, n c vn rt ln trong vic din dch cho mt c nhn.
Chng hn nh nu ti ni Xc sut m bn b ung th l 0.10 th iu c ngha l
g? N c ngha l trong 100 ngi nh bn, c 10 ngi b ung th. Ni cch khc, n
l mt con s p dng cho mt qun th, ch khng phi cho mt c nhn. y th m
cu pht biu dng cho mt c nhn! Do , c ngi cho rng mt pht biu nh th
hon ton v ngha, bi v mt c nhn l ch 1 c nhn, m 1 c nhn th khng c mu
s.

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Mt nh ngha th hai c xut t th k 17 l trng phi xc sut ch quan

(subjective probability). Theo trng phi ny, xc sut l mt din t c nhn. Chng
ta s dng xc sut hng ngy nhng khng . Chng ta vn thng ni Hm nay
chc tri ma qu, hay Ti thy anh hnh nh b cm lnh. l nhng cm nhn c
nhn v mt s kin, mt tnh trng, nhng l nhng cm nhn khng chc chn (tc bt
nh). Cch pht biu nh trn l mt cch din t mi lin h ca mt c nhn i vi
mt s kin, n khng phi l mt c tnh khch quan ca s kin. Chnh v th m c
ngi ngh chng ta nn ni xc sut v s kin (probability for an event), ch
khng nn ni xc sut s kin (probability of an event). Xc sut, theo trng phi
ny, l mt s o v s bt nh (degree of uncertainty), hay mt s o v mc tin
tng (degree of belief). Quay tr li cu ni Xc sut m bn b ung th l 0.10, theo
cch hiu ny, l mt cm nhn ch quan ca c nhn ngi pht biu n bnh nhn.
Khng c cch g chng minh cu pht biu ng hay sai (ngoi tr xc sut l 0
hay 1).

Odds v xc sut
Tt c din gii trn ch ni mt im: nguy c l xc sut, nhng xc sut c
th thiu theo trng phi ch quan hay trng phi tn s.
Xc sut khc vi odds. Odds l mt khi nim c th trong vn ha nh bc,
v ch c ngi Anh mi c thut ng odds, khng c ngn ng no trn th gii c ch
odds!
Nu trong s 100 bnh nhn c 10 ngi mc bnh trong mt thi gian theo di,
th nguy c mc bnh (k hiu p) l:
p = 10 / 100 = 0.10
hay 10%. Nhng odds c nh ngha l:
odds =

p
1 p

v trong v d trn, chng ta c:

odds =

0.10
= 0.11
0.90

C ngha l c 11 ngi khng mc bnh th c 1 ngi mc bnh. ng nhin, nu

nguy c p = 0.5 (hay 50%) th odds = 1, hay nu p = 0.9, th odds = 9. Ni cch khc,
gi tr ca xc sut hay nguy c dao ng trong khong 0 v 1, nhng odds khng c gii
hn v gi tr, c th gn 0 m cng c th v hn. Nhng c hai u l s dng. Qua
v d v nh ngha trn, chng ta thy odds khng phi l xc sut, v khng th xem l
nguy c.

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nh ngha OR, RR v HR
Cc ch s OR, RR v HR u o lng mc tng quan (magnitude of
association) gia mt yu t nguy c (risk factor) v nguy c mc bnh (risk of disease).
Nhng ngha tht ca chng c khi khc nhau. hiu r cc nh ngha ny, chng ta
s xem qua kt qu ca ba nghin cu sau y (ti s ch trng n RR v OR, v HR gn
nh l RR v s c gii thch trong mt phn sau):
Nghin cu 1: zoledronic acid v gy xng. Trong mt nghin cu gn y
v nh hng ca zoledronic acid, mt loi thuc chng long xng v nga gy xng
trong gia nh bisphosphonates, cc nh nghin cu tuyn chn 7736 ph n sau mn
kinh, tui t 65 n 89 (Black DM, et al. N Engl J Med 2007 May 3;356(18):1809-22).
H ngu nhin chia cc i tng nghin cu thnh 2 nhm: nhm 1 gm 3875 bnh
nhn c iu tr vi zoledronate, v nhm 2 gm 3861 bnh nhn trong nhm i
chng khng c tim zoledronate m ch ung calcium v vitamin D (cn gi l nhm
chng). Sau 3 nm theo di, c 92 ngi (t l 2.4%) trong nhm zoledronate gy xng,
v 310 ngi (hay 8.0%) trong nhm chng b gy xng t sng (vertebral fracture):
Bng 1. Tm lc kt qu nghin cu theo tng nhm i
tng sau 3 nm nghin cu v hiu qu ca zoledronic
acid.
Nhm
Zoledronate

Nhm chng
(Placebo)

3783

3551

92

310

3875

3861

Khng gy xng
Gy xng t sng
Tng s

Nghin cu 2: T vong trn tu Titanic. Ngy 10/4/1912, tu du lch Titanic

ch 1309 du khch gp nn. Trong tai nn ny c 809 ngi khng may mn t vong.
S ngi t vong v sng st c phn chia theo hng v nh sau:
Bng 2. Tai nn tu Titanic v t vong theo hng hnh
khch
Cht

Sng

123

200

II + III

416

300

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Tng s
809
500
Ngun: http://lib.stat.cmu.edu/S/Harrell/data/descriptions/titanic3info.txt
Nghin cu 3: ung th phi v ht thuc l. Mt cng trnh nghin cu bnh
chng mang tnh lch s, v y l cng trnh ln u tin cho thy ngi ht thuc l c
nguy c mc bnh ung th phi. Nghin cu do Richard Doll v Bradford Hill thc hin.
H chn 649 ngi mc bnh ung th phi, v 649 ngi khng mc bnh (nhm
chng). sau , h tm hiu tin s ht thuc l. Kt qu ca cng trnh lch s ny c
th tm lc nh sau (R Doll and B Hill. BMJ 1950; ii:739-748):
Bng 3. Tn s ht thuc l trong nhm ung th phi v
khng ung th phi.

Ht thuc l

Ung th phi

Nhm chng

647

622

27

649

649

Khng ht thuc l
Tng s

Nghin cu 1 l nghin cu can thip trong m hnh randomized controlled trial (tc lm
sng i chng ngu nhin), nhng nghin cu 2 v 3 l nhng nghin cu quan st (tc
khng can thip). C th xem nghin cu 2 l mt nghin cu ct ngang (cross-sectional
study hay mt survey), v nghin cu 3 l nghin cu bnh chng.
Trong nghin cu 1, chng ta c th c tnh nguy c gy xng cho nhm iu tr (p1)
v nhm chng (p2) nh sau:
p1 =

92
= 0.024
3875

p2 =

310
= 0.080
3861

Relative risk (RR, hay c khi cn c gi l risk ratio) c nh ngha l t s ca

hai nguy c:
RR =

p1 0.024
=
= 0.295
p2 0.080

[1]

Ni cch khc, nguy c gy xng trong nhm bnh nhn iu tr bng zoledronic acid
gim ~71% so vi nhm chng.
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Nhng nh ngha odds th khc. Vn ly v d trn, odds ca nhm iu tr l (O1):

O1 =

0.024
= 0.0243
1 0.024

O2 =

0.080
= 0.0872
1 0.080

V odds ca nhm chng:

Odds ratio (OR) c nh ngha l t s ca hai odds:

OR =

O1 0.0243
=
= 0.279
O2 0.0872

[2]

Chng ta thy trong trng hp ny, RR v OR khng khc nhau ng k. Nhng

ngha ca RR th d din gii hn v chng ta bit l t s ca 2 nguy c, cn ngha
ca OR th phc tp hn, v l t s ca 2 odds v odds khng phi l nguy c hay xc
sut!
RR v OR cng c th c tnh cho nghin cu ct ngang nh trng hp tai nn
tu Titanic. Nhng trong trng hp ny, t l t vong khng phi l mt incidence (t
l pht sinh) m l prevalence (t l hin hnh) v khng c yu t thi gian y. Gi
t l t vong cho nhm hnh khch hng I l P1 v hng II+III l P2, chng ta c:
P1 =

123
= 0.381
123 + 200

P2 =

416
= 0.581
416 + 300

Do , RR l:
RR =

P1 0.381
=
= 0.655
P2 0.581

[3]

Bi v y l mt nghin cu ct ngang, P1 v P2 thc cht l prevalence, cho nn

trong gii dch t hc khng ai gi l RR (nh ti va vit); h c mt thut ng khc
thch hp hn: l prevalence ratio (PR). Tuy nhin, ngy nay, thut ng prevalence
ratio rt t c s dng, v thay vo , ngi ta s dng mt thut ng chung khc c
tn l risk ratio, vn vit tt l RR. Ni cch khc, RR (risk ratio) l tn gi chung cho
relative risk v prevalence ratio.
By gi, chng ta th tnh OR theo trnh t trn. Trc ht l odds t vong ca
nhm hnh khch hng I:

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O1 =

123
= 0.615
200

V odds t vong cho nhm hnh khch hng II v III:

O2 =

416
= 1.387
300

Do , odds ratio t vong ca nhm hnh khch hng I so vi nhm hng II v III l:
OR =

O1 0.615
=
= 0.443
O2 1.387

[4]

Con s RR = 0.655 trn cho chng ta bit hnh khch hng I c nguy c t vong
trong tu Titanic thp hn hnh khch hng II v III khong 35% (ly 1 tr cho 0.655).
Nhng OR l 0.443, v nu c ngi can m din gii rng nguy c t vong ca
nhm hnh khch hng I thp hn nhm hng II v III l 56% th s rt sai. Sai l v vi
OR chng ta khng c th ni v nguy c hay risk, do n v ca OR l odds.
Ti sao trong nghin cu 1, RR v OR rt gn nhau, nhng trong nghin cu 2
RR v OR qu khc nhau? Nhn k cng thc tnh RR v OR, chng ta d dng thy mt
mi lin h hu c (nu bn no thch i s c th lm mt chng minh), v mi lin
h ny cho chng ta thy nu t l (nguy c) bnh thp (nh di p < 0.1) hay rt thp
(p < 0.01) th OR rt gn vi RR, nhng khi nguy c bnh cao (nh trn p > 0.2) th
OR lc no cng cao hn RR. Ni cch khc, OR lc no cng cao hn RR v mc
khc bit cng ln khi nguy c bnh cng cao (nh nghin cu 2, khi P trn 0.35).
Bng sau y trnh by 10 nghin cu (tng tng) m tt c u c RR bng 3,
nhng OR khc nhau. Nh c th thy qua bng ny, khi nguy c mc bnh cng cao th
OR cng cao hn RR.

Bng 4. So snh gia OR v RR theo tn s mc bnh

Nghin
cu

Nguy c mc bnh

Odds of disease

Nhm 1
(p1)
0.001

Nhm 2
(p2)
0.003

Nhm 1
(O1)
0.002

Nhm 2
(O2)
0.003

0.01

0.03

0.01

0.02

0.06

0.05

0.10

So snh gia
RR v OR
RR

OR

3.01

0.03

3.06

0.02

0.06

3.13

0.15

0.05

0.18

3.35

0.30

0.11

0.43

3.86

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0.15

0.45

0.18

0.82

4.64

0.20

0.60

0.25

1.50

6.00

0.25

0.75

0.33

3.00

9.00

0.30

0.90

0.43

9.00

21.0

10

0.33

0.99

0.49

99.0

2101.0

Th th cu hi t ra l ti sao chng ta cn OR? Ti v c mt s m hnh

nghin cu m chng ta khng th c tnh RR, m ch c th c tnh OR. Mt trong
nhng m hnh nghin cu chnh l nghin cu bnh chng (nghin cu 3). Trong
nghin cu bnh chng, chng ta bit trc c bao nhiu ngi mc bnh v khng mc
bnh, v chng ta i ngc qu kh tm hiu yu t nguy c. Do , chng ta khng
th c tnh nguy c, nhng c th c tnh odds.
Quay li vi kt qu ca nghin cu 3, chng ta tnh ton odds ht thuc l cho
nhm ung th phi (gi tt l O1):
O1 =

647
= 323.5
622

V odds ht thuc l cho nhm chng:

O2 =

622
= 23.04
22

T , OR c c tnh:
OR =

O1 323.5
=
= 14.04
O2 23.04

Ch s OR ny c din gii nh sau: odds ung th phi trong nhm ht thuc l

cao hn nhm khng ht thuc l 14 ln. Xin nhn mnh rng chng ta ch ni odds ch
khng phi risk (nguy c).
Nhng nh chng ta va thy qua nghin cu 1, khi tn s bnh trong cng ng
thp th OR c th xem l RR. Chng ta bit rng ung th phi l mt bnh c tn s
thp trong cng ng, cho nn OR = 14 c th din gii rng nguy c mc bnh ung th
trong nhm ht thuc l cao hn nhm khng ht thuc l 14 ln.

Khi nim v hazard

Hazard thng c dch sang ting Vit l may ri hay ri ro. Nhng trong
thut ng dch t hc c ngha l lc nguy c, v nh dn s hc Gompertz s dng t ny
ln u vo nm 1825 ch ci m ng gi l Force of mortality (lc t vong). Ngy
nay, t ai s dng force of mortality m ch ni nguy c. Do , hazard ratio (HR)

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cng c khi c xem l risk ratio (RR). C th xem incidence l tng ng vi khi
nim tc (velocity) bn vt l, v hazard l gia tc (acceleration) ca vt l.
hiu hazard ratio, chng ta th xem qua mt nghin cu dn s dch t hc m
trong cc nh nghin cu c tnh t l t vong ca nhng ngi trong tui 50-54,
55-59, 60-64 v 65-69 nh sau:
Bng 5. T l t vong tnh trn 100,000 dn s M 1990
Nguyn nhn t
vong
Ung th phi
Tim mch

50-54

55-59

60-64

65-69

91.1
276.1

176.0
473.6

289.9
766.6

399.1
1197.2

Cu hi t ra l: i vi nhng n ng 50 tui, nguy c t vong trong vng 10

nm v ung th phi so vi bnh tim mch l bao nhiu? Nhng trong nghin cu trn,
chng ta ch theo di t vong trong vng 1 nm, cho nn cu hi trn kh c cu tr li
chnh xc. Tuy nhin, iu may mn l cc nh nghin cu c nhiu tui khc nhau.
Do , chng ta c th c tnh nguy c tch ly (cumulative risk). Hm s nguy c tch
T

ly c th hi phc tp mt cht nhng c th vit n gin nh sau: U k (T ) = k (t )dt ;

0

trong , hm k (t ) l hm t vong, T = 10 nm (theo cu hi tnh t 50 tui). Qua vi

thao tc i s, chng ta c th c tnh xc sut t vong cho ngi 50 tui trong vng 10
nm v bnh ung th phi (k hiu P1) nh sau:
(91.1 5) + (176.0 5)
P1 = 1 exp
= 0.013266
100,000

V nguy c t vong v bnh tim mch l:

(276.1 5) + (473.6 5)
P2 = 1 exp
= 0.0376791
100,000

Ch trong cch tnh trn, chng ta phi nhn t l t vong cho 5 v trong mi nhm tui,
khong cch l 5 (nh 50 n 54). Mu s 100,000 l v t l trong bng trn c tnh
trn 100,000 dn s.
T , hazard ratio c nh ngha l t s ca hai nguy c tch ly:
HR =

P1 0.013266
=
= 0.36
P2 0.037679

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Ni cch khc, nguy c t vong v ung th phi thp hn nguy c t vong v bnh tim
khong 64%.

Tm lc
kt thc bi ny, Bng 6 sau y tm lc mi lin h gia OR, RR v HR.
Ti mun nhc li mt s im chnh nh sau:
Khi nim nguy c l xc sut, khc vi khi nim odds khng phi l xc sut
m ch l mt t s. Do , v din gii, OR khng th din gii bng ngn ng nguy c,
nhng trong vi trng hp th OR cng c th xem l RR.
Trong dch t hc, chng ta mun c tnh relative risk (RR), cn c khi gi l
risk ratio. Nhng v trong nghin cu bnh chng, chng ta khng th c tnh RR, nn
phi c tnh OR. Do , OR chnh l mt c s (estimate) ca RR.
Nhng v OR rt d tnh, nn OR c th tnh cho bt c m hnh nghin cu
no (nh nghin cu bnh chng, ct ngang, hay nghin cu xui theo thi gian -prospective study). Nhng vi cc nghin cu m tn s bnh kh cao (trn 10%) th OR
lc no cng c tnh RR cao hn thc t (over-estimation). Chnh v th m ngy nay,
nhng ai hiu vn khng s dng OR hay hi qui logistic cho cc nghin cu nh th.
Tuy nhin, tnh prevalence ratio hay risk ratio trong cc nghin cu nh th i hi
phi bit s dng chng trnh R phn tch thch hp.
RR (relative risk hay risk ratio) ch c th c tnh cho nghin cu xui theo thi
gian hay ct ngang, ch khng th tnh t nghin cu bnh chng. HR ch c th c
tnh cho cc nghin cu xui theo thi gian vi iu kin chng ta bit chnh xc thi
im hay thi gian m bin c lm sng xy ra.
V mt thng k, OR c c tnh qua m hnh hi qui logistic; RR c tnh qua
m hnh hi qui Poisson hay hi qui nh phn; v HR th c tnh ch qua m hnh hi qui
Cox (Coxs proportional hazard model). Ti s bn qua cch phn tch v din gii cc
m hnh nh phn trong mt bi sau, nhng phn ph ch di y gii thch s qua v
m hnh Poisson.
Bng 6. Phn bit mt s ch s o lng nh hng, thut ng v phng php
phn tch
Ch s

Ngun gc

Tn gi khc

Odds ratio

Odds ratio
(Cornfield,
1951)
Relative risk

Cross-product
ratio

Relative risk

Risk ratio

Lut phn
phi
Nh phn
(binomial
distribution)
Poisson hay

Phng php
phn tch
Hi qui logistic
(Cox, 1958)
Poisson

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10

(Cornfield,
1951)

Hazard ratio

Intensity of
mortality ratio
(Gompertz
1825)

Nh phn

Force of
mortality

Exponential,
Poisson

regression
(Cochran,
1940; Kutner
v Beauchamp
1973)
Coxs
proportional
hazards (Cox
1972)

Ph ch:
Mt dng nghin cu khc cng c th s dng risk ratio qua v d sau y. S
liu sau y l s trng hp mc bnh ung th da ph n thuc thnh ph song sinh
Minneapolis St Paul (M):

tui
15-24
25-34
35-44
45-54
55-64
65-74
75-84
85+

S trng
hp ung
th da
1
16
30
71
102
130
133
40

Dn s

T l pht sinh
trn 1000 dn s

172,675
146,207
121,374
111,353
83,004
55,932
29,007
7,538

0.0058
0.1094
0.2472
0.6376
1.2289
2.3243
4.5851
5.3064

Da vo hai s liu trn, chng ta c th c tnh t l pht sinh (incidence rate)

tnh trn 1000 dn s, v t l ny c trnh by trong ct cui cng ca bng s liu.
Chng ta d dng thy t l pht sinh ung th da tng theo tui.
Chng ta cn mt m hnh m t xu hng trn, hay mi lin h gia tui
v t l pht sinh. y, c mt kh khn l dn s khc nhau gia cc tui, m t l
th ty thuc vo tui. Cho nn chng ta cn mt m hnh c th iu chnh cho hai
yu t ny. Mt m hnh thch hp cho trng hp ny l m hnh hi qui Poisson.

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Gi Ni l dn s ca tui ith (ct s 3 trong bng trn), v gi i l s trng

hp ung th da (ct s 2), chng ta c th xem t s

(ct s 4) nh l mt t l pht
Ni
sinh bnh. By gi, tin cho vic tnh ton, chng ta hon chuyn t s ny sang n
v logart:

log i
Ni

= log( i ) log( N i )

[1]

M hnh ny pht biu rng log ca t l pht sinh, tc l log i , l mt hm s ca
Ni
tui (v chng ta k hiu tui bng x). Ni cch khc, m hnh ny pht biu rng:

log i
Ni

= + xi

[2]

Thay th [1] vo v tri ca [2], chng ta c:

log( i ) log( N i ) = + xi
hay ni cch khc:
log( i ) = + xi + log( N i )

[3]

M hnh [3] chnh l m hnh hi qui Poisson (Poisson Regression). Cch din
t m hnh theo cng thc [3] cho php chng ta xy dng mt hm s kh d
(likelihood function) c tnh cc thng s v . Trong m hnh trn, log( N i )
c gi l offset, tc l im nhn.
Chng ta c th s dng R c tnh cc thng s trong m hnh [3] nh sau:
age = c(19.5,29.5,39.5,49.5,59.5,69.5,79.5, 89.4)
cases = c(1, 16, 30, 71, 102, 130, 133, 40)
pop = c(172675, 123065, 96216, 92051, 72159, 54722, 32185, 8328)
dataset = data.frame(age, cases, pop)
fit = glm(cases ~ age + offset(log(pop)), family=poisson,data=dataset)
summary(fit)

Kt qu ca phn tch l:
Deviance Residuals:
Min
1Q
Median
-4.87198 -1.67519 -0.07185

3Q
1.20816

Max
1.99291

Coefficients:
Estimate Std. Error z value Pr(>|z|)

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(Intercept) -10.551604
0.168780 -62.52
<2e-16 ***
age
0.063629
0.002475
25.71
<2e-16 ***
--Signif. codes: 0 '***' 0.001 '**' 0.01 '*' 0.05 '.' 0.1 ' ' 1
(Dispersion parameter for poisson family taken to be 1)
Null deviance: 845.789
Residual deviance: 44.288
AIC: 91.688

on 7
on 6

degrees of freedom
degrees of freedom

Number of Fisher Scoring iterations: 5

Chng ta ch ch n thng s intercept v age. Thay th cc thng s ny vo

m hnh [3] chng ta c:
log( i ) = -10.552 + 0.064 xi + log( N i )
trong , x l tui.
Cng c th vit m hnh trn thnh t l pht sinh (thay v log ca t l) nh sau:

i
Ni

= e 10.552 +0.064 x

Nu tui l 19.5 (x = 19.5), chng ta c th c tnh t l pht sinh l:

i
Ni

= e 10.552+ 0.06419.5 = 0.0000904

Nu tui l 29.5, t l pht sinh l:

i
Ni

= e 10.552+ 0.06429.5 = 0.000171

T s ca hai t l pht sinh ny l: 0.000171 / 0.0000904 = 1.89. Ni cch khc, t l

pht sinh tng gp 1.89 ln cho mi 10 tui tng. Con s 1.89 ny cn c tn l risk
ratio.
Tht ra, chng ta c th c tnh ngay t c s ca R:
Coefficients:
Estimate Std. Error z value Pr(>|z|)
(Intercept) -10.551604
0.168780 -62.52
<2e-16 ***
age
0.063629
0.002475
25.71
<2e-16 ***

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Trong phn trn, = 0.0636 c ngha l c mi mt tui tng th t s nguy c tng i

tng e0.0636 = 1.065 (hay tng 6.5%). Do , khi tng 10 tui th nguy c tng i mc
bnh tng e0.0636 x 10 = 1.89, hay 89%.

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