2.

1
AUGUST
2014

Cross Sectional Study

DR. BISO
The adrenaline and stress of an adventure are better than a thousand peaceful days.
Paulo Coelho

Paulo Coelho
CROSS SECTIONAL STUDY

Prevalence Study
Examines relationship between disease and other
variables as they exist in a defined population at one
particular point in time
Look at exposure and outcome variable at one point in
time or over a very short period of time
Collect both exposure and outcome variable at the same
time
Describes prevalence and distribution of a disease or
other variable in a population
How often you see the disease in the population
Is a study to estimate the distribution of a quantity of
interest or joint distribution of several quantities in a
target population, a certain moment in time
Can measure attitudes, beliefs, behaviors, personal/family
history, genetic factors, existing past or past health and or
anything else that does not require follow-up to assess
Useful in:
Planning, prioritization, resource allocation
Determining if an association exists between a
particular disease and suspected exposure factors
Acts as initial stage of a cohort or evaluation study
Relatively easy and inexpensive to conduct
Useful for investigating exposure that are fixed
characteristics of individuals such as ethnicity and blood
group
In sudden outbreaks of disease, to measure several
exposures can be the most convenient first step in
investigating a cause
Useful in assessing health care needs of population
Repeated cross-sectionals using independent random
samples with standard definitions and survey methods
provide useful indication of trends
Each survey should have a clear purpose
Valid surveys need:
Well-designed questionnaires
Appropriate sample of sufficient size
Good response rate
Usually cover a selected sample of the population
Example: impossible to study all children with
measles in a country; so sample lang ang kukunin
CENSUS covers total population of a country; done
every 5 years
Survey of a sample cheaper because fewer resources
needed (human resources, time, money)
May be repeated at later date in order to measure
change in time in the characteristic studied

SAMPLE CASE STUDY

A cross-sectional study has been set up in your
barangay to see if children who are underweight are more
likely to get measles than other children of normal weight. The
study finds that more children who are underweight have
measles than those of are normal weight.
Q: Does this mean that underweight children are more
likely to get measles because they are underweight? Or
that they are more likely to be underweight because the
measles?
A: No conclusion! Because you do not know which came
first (underweight vs measles)

A cross-sectional study cannot resolve uncertainty

because the information was collected at one point in
time.
Measurements of exposure and effect are made at the
same time.
USES OF CROSS-SECTIONAL STUDIES

Establish baseline data

Useful for studying conditions that are:
o Quantitatively measured and that vary over time
o Relatively frequent diseases that have long duration
Likely to catch chronic diseases kasi nga long
duration
Determine the association between an outcome variable
and some explanatory variables
Eg. obesity and hypertension
Monitor changes in a population over time
Eg. IVDU among teenagers
Make inference about disease incidence (but not an
incidence study)
Eg. IVDU and HIV/AIDS

ADVANTAGES

Less costly than cohort

Conducted more quickly
Provide date on disease frequency or prevalence in
population
Provides rates and descriptive information
Can identify the early stage of the disease before it is
clinically important
Do not suffer from loss of follow-up
DISADVANTAGES

Measures effect of both incidence and duration

Cant identify direction of etiologic association (temporal
sequence)
Sensitive to response bias
Sensitive to observation bias
Series of prevalent cases will have a higher proportion of
cases with disease of long duration than a series of
incident cases
Survivors and stayers
WHO INFOBASE

Data warehouse that collects, stores, and displays

information on chronic diseases and their risk factors
186 countries
Improve the access of health professionals and researchers
Traceable sources and full survey methodology
Options:
o WHO estimates
o Country profiles
o Survey search tool
o Estimated proportional mortality rate
ANALYSIS
A. Determine Prevalence Proportion (PP)
PP = # with disease/condition x 100
# examined
B. Compare PP between and among the different
subgroups

MEASURES OF ASSOCIATION

RATIO MEASURES
o A ratio measure of association or effect
o A frequency measure for 1 exposure group
o Comparable frequency measure for the unexposed
o For prevalence comparison
Prevalence Ratio = Prevalence Proportion (E)
Prevalence Proportion (U)

Determine magnitude of disease that is important for

priority setting
Hypothesis generation
Evaluate medical care and health care services

TRANSCRIBED BY: CRUZ, CUA

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CROSS SECTIONAL
STUDY

Eg. PR = 1.92
Children with a history of abuse are almost 2
times more likely to have mental illness as
those with no history.

DIFFERENCE MEASURES
o Calculated by subtracting frequency
Prevalence Difference = PP (E) PP (U)

Eg. PD = 19.39
19 per 100 cases of mental illness are likely
to be seen at the time of exam among
children with history of child abuse compare
to them without history.

POTENTIAL BIASES

RESPONSE BIAS
o disease occurrence may be usually different between
those who joined and those who did not join the study
o pinili mo yung exposed kaya overestimate yung
prevalence rate
INFORMATION BIAS
o disease
status
and
exposure
are
measure
simultaneously
SELECTION BIAS
o The Healthy Worker Effect
o Only healthy workers are available for study
o Eg. decrease asthma rates in animal handlers; person
contracting asthma quit and are not available for
study
SAMPLE PROBLEM
Indoor Cooking

With Asthma

Without Asthma

Yes

200

100

No

20

180

A. Prevalence Proportion
PP (E) = 200/300 = 0.66
PP (U) = 20/200 = 0.1
B. Prevalence Ratio
PR
= PP (E) / PP (U)
= 0.66/0.1
= 0.66

Among subjects with history of indoor cooking are 6.6 times

more likely to have asthma than subjects with no history of
indoor cooking.
C. Prevalence Difference
PD
= 0.66 0.1
= 0.56
There are 50/100 more cases of asthma among subjects with
history of indoor cooking compared to those without history
of indoor cooking.

TRANSCRIBED BY: CRUZ, CUA

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