Sample size and power based on the population attributable fraction

Most methods for calculating sample size use the relative risk (RR) to indicate the strength of the association between exposure and disease. For measuring the public health importance of a possible association, the population attributable fraction (PAF) - the proportion of disease incidence in a population that is attributable to an exposure - is more appropriate. We determined sample size and power for detecting a specified PAF in both cohort and case-control studies and compared the results with those obtained using conventional estimates based on the relative risk. When an exposure is rare, a study that has little power to detect a small RR often has adequate power to detect a small PAF. On the other hand, for common exposures, even a relatively large study may have inadequate power to detect a small PAF. These comparisons emphasize the importance of selecting the most pertinent measure of association, either relative risk or population attributable fraction, when calculating power and sample size.