CASE CONTROL AND

COHORT STUDY
INSTITUTE OF COMMUNITY MEDICINE
MADURAI MEDICAL COLLEGE
CASE CONTROL STUDY - ODD’S RATIO
COHORT STUDY -RELATIVE RISK
Question 1
A study was conducted to find out the effects of forceps delivery

on mental development of children. The subjects were 50 mentally

retarded and 100 normal children in the age group of 5 years. On

analyzing the records it was found that the outlet forceps was applied at

the time of delivery in 12 children in mentally retarded group and 6 in

normal group. Find out the odds ratio and give your inference.
• a) Type of study: case control study

Exposure Mentally Normal

Outlet retarded
forceps
Positive 12(a) 6(b)

Negative 38 (c) 94 (d)

50 ( a+c) 100 ( b+d )

•
Question 2

• In a study of 500 cases of lung cancer 60 were found to be heavy

smokers. In another group of 500 nonlung cancer the frequency of

heavy smokers were 6.

- What type of study design is this?

- Write the framework and analysis.

- Do you think heavy smoking and lung cancer are related?

• Type of study: case control study

Risk factor( Cases Controls

heavy smoking)

Positive 60(a) 6(b)

Negative 440 (c) 494 (d)

500 ( a+c) 500 (b+d)

• Analysis

b) Exposure rate among cases = a/(a+c)= 60/(60+440) =

60/500=12%

Exposure rate among controls = b/(b+d)= 6/(6+494)= 6/500=1.2%

Odds ratio =ad/bc=(60 x 494)/(6 x 440) =11.15

Comment: Heavy smoking and lung cancer - Association is present

 Question 3
• 50 persons working in a chemical factory were followed by you for 3

months of whom 38 had developed dermatitis. Another 50 persons

from general population who were not working in that factory were

also followed up for the same period of whom 8 developed

dermatitis.

- What is the type of the study conducted?

- Calculate the relative risk and attributable risk and comment

• a) Type of study: cohort study

Disease + Disease -

Exposed to 38(a) 12(b)

factor
Not 8(c) 42(d)
Exposed to
factor
 Relative risk is the ratio of the incidence of the disease (or death)
among exposed and the incidence among unexposed
Attributable risk is the difference in incidence rates of disease (or
death) between an exposed group and non exposed group

Incidence: Among exposed = a/(a+b)= 38/(38+12)= 38/50=0.76

Among not exposed = c/(c+d)= 8/(8+42)= 8/50=0.16

Relative risk = incidence among exposed /incidence among unexposed

= 0.76/0.16 =4.75

( Relative risk = 1: no association : Relative risk >1: positive

association )
 Attributable risk = (incidence among exposed –incidence among not
exposed)/incidence among exposed x100
= (0.76-0.16) / 0.76 X 100
= 0.6/0.76 X 100
= 78.94% = 79%.
COMMENT

1. There is a positive association between exposed factor and diseases

(dermatitis).The persons exposed to chemical are having 4.75 times of risk
than to the non exposed

2. By effective preventive measures 79% of dermatitis can be reduced

among workers in the factory
 Question 4
I n an attem pt to m easure the effec t of birth weight on the
subsequent growth of children a study was carried out. 300 children
wi th b i r th we i g ht 2 kg to 2 .5 kg we re f o l l o we d ti l l ag e 1 , whe n
anthropometric measurements were made to assess nutritional status.
A similar number of children born during the same period with weight
greater than 2.5kg were also similarly followed-up. The information on
socio-economic status of the families was also obtained. The following
were the results.
 Birth Weight

Low Normal

No. of children
300 300
studied

No. of malnourished
105 55
at age 1
• What type of study is this and what is the exposure factor that is

being studied in the case?

• What is the incidence of malnutrition among the exposed?

• What is the incidence of malnutrition among the unexposed?

• What is the relative risk and Attributable risk and comment.

• Describe in one sentence what this relative risk means to you.

 Type of study: cohort study
Exposure factor studied: birth weight

malnourished

yes N0

Low birth weight 105 (a) 195 (b)

Normal weight 55 (c) 245 (d)

•
•
 Question 5
• During 2008 a rural community in Tamil Nadu was surveyed and

several of their characteristics like age sex occupation and blood

pressure smoking habits etc. were documented. All cases of
coronary heart diseases were also identified with the help of
cardiologist and ECG examination. The population was followed up
for the incidence of coronary heart disease and deaths due
myocardial infarction for next three years. The following results
pertain to the incidence of disease according to the smoking status.
 MI
-ve +ve
Non Smokers 4455 50
Smokers <20 2450 55
cigarettes

Smokers >20 1455 50

Cigarettes
 1.What type of study it is?

2.Calculate the relative risk

3.Comment on the association between cigarette smoking and

myocardial infarction.
• Type of study: Cohort study
MI

Yes No

Smoker<20
55(a) 2445 (b)
cigarettes
Non smoker 50( c) 4450(d)
•
 MI

Yes No(healthy)

Smoker>20
50(a) 1450 (b)
Cigarettes
Non smoker 50( c) 4450(d)
Incidence among exposed = a/(a+b) =
50/(50+1450) =
50/1500 = 0.033

Incidence among unexposed = c/(c+d) =

50/(50+4450) =
50/4500 = 0.011

Relative risk = incidence among exposed/incidence

among unexposed
= 0.033/0.011 = 3
Comments

Association between cigarette smoking and MI:

i. Risk of incidence of MI among smokers (< 20

cigarettes) is 2 times the risk in unexposed group

ii. Risk of incidence of MI among smokers (>20

cigarettes) is 3 times the risk in unexposed group

ASSESSMENT
QUESTIONS
1.ODD’s ratio formula ( 1 mark )

2. Relative Risk formula ( 1 mark )

3. In a study of 200 smokers & 600 non smokers were followed up

over a period of 10 years to find out incidence of hypertension. Out of
200 smokers ,60 developed hypertension, as compared to 600 non
smokers of which 30 developed hypertension.

a. what type of study is this ?

b. what will you calculate & what is your inference ? ( 4 marks )

4. To investigate the effect of tobacco on oral cancer , it was

observed 345 out of 490 cancer patients were tobacco chewers , as

compared to 97 out of 490 control subjects.

a. what type of study is this

b. what will you calculate and what is association between

tobacco and oral cancer ( 4 marks )

THANK YOU