Relative risk versus absolute risk: one cannot be interpreted without the other

TLDR

Relative risk, a common measure that condenses two group risks into one number, is widely used but often obscures absolute risks, causing readers to overestimate effects and providing a less informative picture than absolute risk. This article aims to clarify the concepts of relative and absolute risk measures. The authors recommend reporting both relative risk and absolute risk, each with 95 % confidence intervals, to give a complete view of effect size and clinical relevance. Illustrating with nephrology examples, the authors show that without accompanying absolute risks, relative risk ratios mislead readers and prevent accurate assessment of clinical impact.

Abstract

For the presentation of risk, both relative and absolute measures can be used. The relative risk is most often used, especially in studies showing the effects of a treatment. Relative risks have the appealing feature of summarizing two numbers (the risk in one group and the risk in the other) into one. However, this feature also represents their major weakness, that the underlying absolute risks are concealed and readers tend to overestimate the effect when it is presented in relative terms. In many situations, the absolute risk gives a better representation of the actual situation and also from the patient's point of view absolute risks often give more relevant information. In this article, we explain the concepts of both relative and absolute risk measures. Using examples from nephrology literature we illustrate that unless ratio measures are reported with the underlying absolute risks, readers cannot judge the clinical relevance of the effect. We therefore recommend to report both the relative risk and the absolute risk with their 95% confidence intervals, as together they provide a complete picture of the effect and its implications.