Two-by-Two Table

Cornerstone in epidemiological
research

SEARO – CSR Training on Outbreak Investigation

 Learning Objectives

• At the end of the presentation, the

participants will be able to:
– Use two-by-two table for computation of
epidemiological data
– Define measures of associate and indicate use

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 ‘Every epidemiologic study can be
summarized in a two-by-two table.’
- H. Ory

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 Two-by-two Table

• Cornerstone of all
epidemiological research
• Often the first thing one draws
up when starting to investigate
some data

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 Two-by-two Table
ill not ill

Exposed a b a+b

Not
c d c+d
exposed

a+c b+d Total

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 The legend

ill not ill

a = ill and exposed
exposed a b b = well and exposed
c = ill and not exposed
not
exposed c d
d = well and not exposed

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 The legend
ill not ill

exposed a b a+b Total number exposed

not
exposed c d c+d Total number not exposed

a + c b + d Total

Total number of controls/not ill

Total number of cases/ill

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 Example: New Year’s Dinner Outbreak

Food item Ill Not Ill

Eaten Not Eaten Eaten Not Eaten
Cheesecake 4 1 1 9
Quiche 2 3 8 2
Swiss roll 3 2 4 6
Chocolate 1 4 2 8
cake
Cheese dip 4 1 7 3

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
Food item Ill Not Ill
Eaten Not Eaten Eaten Not Eaten
Cheesecake 4 1 1 9

ill not ill

Eat
cheesecake 4 1 a+1
4 b=5

Did not eat

cheesecake 1 9 c
1+d
9 = 10

Total
15
a+1
4 c=5 b1 ++ d9 = 10

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 Number of people who are ill
Attack Rate (AR) =
Number of population at risk

Attack rate close to 1 might give us an idea of possible item in question.

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 ill not ill

Eat
cheesecake 4 1 4+1= 5

Did not eat

cheesecake 1 9 1 + 9 = 10

Total = 15
4 + 1 = 5 1 + 9 = 10
5 4 1
AR = AR exposed = AR not exposed =
15 5 10
= 0.33 = 0.1
= 0.8

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 Using Denominator
Infection by S.Typhimurium
Attack Rate by age group, Jura, May-June 1997
Age group Number of
(years) Cases
<1 2

1–5 36
6 – 14 22
15 – 64 29
> 65 9
Total 98

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 Using Denominator
Infection by S.Typhimurium,
Attack Rate by age group, Jura, may-June 1997

Age Group Number of Cases Population Attack Rate/

(years) 100,000
<1 2 522 383
1–5 36 16,014 225
6 – 14 22 30,385 72
15 – 64 29 157,989 18
> 65 9 41,948 22
Total 98 246,858 40

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 Use of Two-By-Two Table in
Measures of Association

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 ill not ill
a+b
Cohort studies
Exposed 4 1 4+1=5

c+d
Not exposed 1 9 1 + 9 = 10

a+c b+d Total = 15

4+1=5 1 + 9 = 10
a/(a + b)
Relative Risk (RR) =
c/(c +d)
0.8
= 0.1
RR = 1 no association
RR > 1 there is association = 8
RR < 1 some way protective

Relative Risk = the risk in the exposed group divided by the risk in the unexposed group
Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 case control
Case control studies
a+b
Exposed
Open well
30 25 30 + 25 = 55 When true size of the exposed
and unexposed groups is
c+d unknown
Not exposed
Open well 32 60 32 + 60 = 92 e.g., cholera cases and control and
exposure to shallow well N’Djamena,
a+c b+d Chad, July 2001
30+32 = 62 25+60 = 85
ad
Odds Ratio (OR) = bc
30 x 60
= 25 x 32
OR = 1 no association 1800
OR > 1 there is association = 800
= 2.25
Odds Ratio = the odds for cases divided by odds for control
Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
 References

Giesecke, J. Modern Infectious Disease Epidemiology, 2nd ed. Oxford

University Press. 2002.
Gregg, GB. Field Epidemiology, 2nd ed. Oxford University Press. 2002.
Hennekens, C.H., Buring, J.E., Epidemiology in Medicine. 1st ed. 3rd
printing. Little Brown and Company, 1987.

Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation
Two-by-Two Table
SEARO – CSR Training on Outbreak Investigation