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American Journal of Epidemiology Vol. 133, No. 12: 1199-1209
Copyright © 1991 by The Johns Hopkins University School of Hygiene and Public Health

review-article

Assessing Risk Factors for Transmission of Infection

James S. Koopman1,, Ira M. Longini, Jr.2, John A. Jacquez3, Carl P. Simon4, David G. Ostrow5, William R. Martin6 and David M. Woodcock7

1Department of Epidemiology, University of Michigan Ann Arbor, MI
2Department of Epidemiology and Biostatistics, Emory University Atlanta, GA
3Department of Physiology and Biostatistics, University of Michigan Ann Arbor, MI
4Department of Mathematics and Economics, University of Michigan Ann Arbor, MI
5Department of Psychiatry, University of Michigan Ann Arbor, MI
6Department of Nuclear Physics, University of Michigan Ann Arbor, MI
7Laboratory for Scientific Computation, University of Michigan Ann Arbor, MI

Reprint requests to Dr. James S. Koopman, Department of Epidemiology, University of Michigan, SPH-1, 109 Observatory Street, Ann Arbor, MI 48109-2029.

Commonly used measures of effect, such as risk ratios and odds ratios, may be quite biased when used to assess the effect of factors that alter transmission risks given exposure to infected individuals. This is demonstrated in a simulation model involving a higher-risk behavior and a lower-risk behavior affecting the sexual transmission of human immunodeficiency virus. The bias arises because population contact patterns between higher-risk and lower-risk persons change their relative probabilities of exposure to an infected individual as an epidemic progresses. The assessment of contact patterns is thus central to risk assessment for contagious diseases. A new formulation of selective mixing presented here, together with a structured mixing specmcation of the social settings of contact, provides a theoretic framework for the investigation of contact pattern determinants.

acquired immunodefidency syndrome; epidemiologic methods; HIV; models; theoretical; risk; risk factors; sex behavior


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