ENVIRONMENTAL AND OCCUPATIONAL EPIDEMIOLOGY

COMM 845

BY

HELEN CHIAZOR OKPALA

P20DLPH80659
 ASSIGNMENT

What is cohort study?

What are the strengths of cohort study?

A cohort study is an observational study design in which groups of subjects are identified based
on their exposure to a particular risk factor and then compared to a group that have not been
exposed to that same factor. This study design can be conducted from either a forward-looking
(i.e., prospective) or backward-looking (i.e., retrospective) viewpoint. A cohort study is similar
in concept to the experimental study. In a cohort study the epidemiologist records whether each
study participant is exposed or not, and then tracks the participants to see if they develop the
disease of interest. Note that this differs from an experimental study because, in a cohort study,
the investigator observes rather than determines the participants’ exposure status. After a period
of time, the investigator compares the disease rate in the exposed group with the disease rate in
the unexposed group. The unexposed group serves as the comparison group, providing an
estimate of the baseline or expected amount of disease occurrence in the community. If the
disease rate is substantively different in the exposed group compared to the unexposed group, the
exposure is said to be associated with illness.

The length of follow-up varies considerably. In an attempt to respond quickly to a public health
concern such as an outbreak, public health departments tend to conduct relatively brief studies.
On the other hand, research and academic organizations are more likely to conduct studies of
cancer, cardiovascular disease, and other chronic diseases which may last for years and even
decades. The Framingham study is a well-known cohort study that has followed over 5,000
residents of Framingham, Massachusetts, since the early 1950s to establish the rates and risk
factors for heart disease. The Nurses Health Study and the Nurses Health Study II are cohort
studies established in 1976 and 1989, respectively, that have followed over 100,000 nurses each
and have provided useful information on oral contraceptives, diet, and lifestyle risk factors.
These studies are sometimes called follow-up or prospective cohort studies, because participants
are enrolled as the study begins and are then followed prospectively over time to identify
occurrence of the outcomes of interest.

An alternative type of cohort study is a retrospective cohort study. In this type of study both the
exposure and the outcomes have already occurred. Just as in a prospective cohort study, the
investigator calculates and compares rates of disease in the exposed and unexposed groups.
Retrospective cohort studies are commonly used in investigations of disease in groups of easily
identified people such as workers at a particular factory or attendees at a wedding. For example,
a retrospective cohort study was used to determine the source of infection of cyclosporiasis, a
parasitic disease that caused an outbreak among members of a residential facility in Pennsylvania
in 2004.The investigation indicated that consumption of snow peas was implicated as the vehicle
of the cyclosporiasis outbreak.
Strength of Cohort Study

A major advantage of the cohort study design is the ability to study multiple outcomes that can
be associated with a single exposure or multiple exposures in a single study. Even the combined
effect of multiple exposures on the outcome can be determined. Cohort study designs also allow
for the study of rare exposures. Investigators can specifically select subjects exposed to a certain
factor. Furthermore, cohort studies often have broader inclusion and fewer exclusion criteria
compared with randomized controlled trials. The investigators may obtain large samples and
reach greater power in statistical analysis relative to a randomized controlled trial. For these
reasons, results from cohort studies may be more generalizable in clinical practice. Finally, the
longitudinal nature of cohort studies means that changes in levels of exposure over time, and
changes in outcome, can be measured to provide insight into the dynamic relation between
exposure and outcome. Prospective and retrospective studies have different strengths and
weaknesses. Prospective cohort studies are conducted from the present time to the future, and
thus they have an advantage of being accurate regarding the information collected about
exposures, end points, and confounders. The disadvantage could be the long period of follow-up
while waiting for events to occur, leading to vulnerability to a high rate of loss to follow-up.
Retrospective studies rely on data collected in the past to identify both exposures and outcomes.
These studies use data that have already been collected, such as would be obtained using a
database extracted from electronic medical records. Thus, cohort studies are often time efficient
and cost-effective. However, many retrospective cohort studies use data that were collected in
the past for another objective. Hence, the investigators lack control over the collection of data.

Advantages

 Can investigate multiple outcomes that may be associated with multiple exposures.

 Able to study the change in exposure and outcome over time.

 Good for examining rare exposures.

 Can measure incidence of outcome.

 May be able to infer causality.

Advantages of Prospective Study and Retrospective Study

 Able to control design, sampling, data collection, and follow-up methods

 Time-efficient and inexpensive

 Can measure all variables of interest

 Easy to obtain large sample

 References

Kannel WB., & J Atheroscler (2000). The Framingham Study: its 50-year legacy and future
promise.Thromb.6:60-6.

Rothman, K. J., Greenland, S., & Lash, T. L. (2008). Modern epidemiology (Vol. 3).

Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Merrill, R. M. (2015). Introduction to epidemiology. Jones & Bartlett Publishers.

Euser, A. M., Zoccali, C., Jager, K. J., & Dekker, F. W. (2009). Cohort studies: prospective
versus retrospective. Nephron Clinical Practice, 113(3), c214-c217.