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Question

In a town, a study was carried out to determine the role of cigarette smoking in causation of lung cancer. It was found that a total of 7000 people in the town were smokers. Of them, 70 developed lung cancer. In the same town, 3000 people were non-smokers. Of them, 3 developed lung cancer. Given these numbers, what would be the attributable risk to cigarette smoking for lung cancer?

The correct answer is

30%

Concept: Attributable Risk (Attributable Risk Percent)

Attributable Risk (AR) is the amount of disease incidence that can be directly attributed to a specific exposure — here, cigarette smoking. It is calculated as the difference between the incidence rate of disease in the exposed group and the incidence rate in the unexposed group, expressed as a percentage of the incidence in the exposed group.

Step 1: Incidence in Smokers (Exposed Group)

  • Total smokers = 7,000
  • Developed lung cancer = 70
  • Incidence in smokers (Ie) = 70 / 7,000 = 0.01 = 1% (10 per 1,000)

Step 2: Incidence in Non-Smokers (Unexposed Group)

  • Total non-smokers = 3,000
  • Developed lung cancer = 3
  • Incidence in non-smokers (Iu) = 3 / 3,000 = 0.001 = 0.1% (1 per 1,000)

Step 3: Calculating Attributable Risk Percent

$$\text{AR\%} = \frac{I_e - I_u}{I_e} \times 100$$

$$\text{AR\%} = \frac{0.01 - 0.001}{0.01} \times 100 = \frac{0.009}{0.01} \times 100 = 90\%$$

This means that 90% of the lung cancer risk among smokers is directly attributable to cigarette smoking, while the remaining 10% of the risk would exist even without smoking (background/baseline risk).

Why the Other Options Are Incorrect

  • 10% — This is actually the proportion of risk in smokers that is not attributable to smoking (Iu/Ie × 100 = 0.1/1 × 100 = 10%); it is the inverse of the correct answer, not the attributable risk itself.
  • 30% — Does not correspond to any standard attributable risk calculation using the given incidence values; there is no valid epidemiological formula applied to these numbers (Ie = 1%, Iu = 0.1%) that yields 30%.
  • 60% — Also does not match any recognized attributable risk, relative risk, or population attributable risk formula for this dataset.

Key Takeaway

Given Ie = 1% and Iu = 0.1%, the correctly computed Attributable Risk Percent = 90%, making it the mathematically and epidemiologically correct answer for this classic study design comparing smokers and non-smokers.

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Important Questions from General Epidemiology

  1. Which of the following statements are correct for incidence rate? 

    1. It is useful for taking action to control a disease. 

    2. Rising incidence rates may indicate ineffectiveness of the current control programmes. 

    3. Fluctuation in incidence rate may indicate a change in aetiology of disease. 

    Select the answer using the code given below.

  2. Consider the following definition : 

    "A high level of infection beginning early in life and affecting most of the child population, leading to a state of equilibrium such that the adult population shows evidence of the disease much less commonly than the children." 

    Which one of the following terms best fits this definition?

  3. In which one of the following study designs, the unit of study involves populations rather than individuals ?
  4. Which one of the following best explains the relationship among Prevalence (P), Incidence (I) and Duration (D) of a disease given the assumption that the population is stable?
  5. Which one of the following is a famous large prospective study that helped establish risk factors for coronary heart disease?
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