The estimation and interpretation of attributable risk in health research

Various measures of attributable risk are discussed together with a rationale for their use as an alternative to relative risk in health research. Methods of estimation are presented for use with three important kinds of epidemiological study design with one dichotomous risk factor for a dichotomous disease outcome; the study designs are then compared with respect to efficiency. Procedures to analyse confounded, polytomous and interacting risk factors are proposed and it shown that there is a simple relationship between two distinct estimators previously suggested for use with deleterious and beneficial (or preventive) factors. Finally the relevance of attributable risk to an assessment of the potential effects of risk factor modification is discussed in the preventive medicine framework.