STUDI

CROSS SECTIONAL
 STUDI CROSS SECTIONAL

Tujuan:
- mempelajari angka kejadian suatu penyakit/masalah
kesehatan
- mempelajari hubungan antara suatu faktor risiko
dengan angka kejadian suatu penyakit

Unit analisa: individual

Faktor risiko/exposure dan status

penyakit/masalah kesehatan diukur pada
saat yang sama
 STUDI CROSS SECTIONAL
nama lain : studi prevalensi, survey
bersifat observasional

populasi studi merupakan populasi umum

sampel diambil secara random (acak)

setiap orang di populasi mempunyai kesempatan
- yang sama untuk menjadi anggota sampel
sampel representatif /mewakili populasi
 STUDI CROSS SECTIONAL
pengukuran variabel independet (exposure)
dan variabel dependent (outcome) dilakukan
secara simultan, sehingga ::
tidak dapat terlihat sekuens mana yang
terjadi lebih dulu, variabel independent atau
variabel dependent, atau sebaliknya

konsekwensinya tidak dapat melihat

hubungan sebab-akibat
- (exposure harus mendahului outcome )
 Definition
A cross-sectional studies
a type of observational study
the investigator has no control over the exposure of
interest (e.q. diet).

It involves

identifying a defined population at a particular point in

time
measuring a range of variables on an individual basis
e.g. include past and current dietary intake
At the same time measuring outcome of interest
e. g. obesity PRD-5
 Definition
Measurement of exposure of
interest and outcome of interest
is carried out at the same time
(e.g. Obesity and Hypertension)

There is no in-built directionality

as both exposure and outcome
are present in the study subject
for quite some time
PRD-6
Which came first?

?? Causality

PRD-7
PRD-8
 Study Design

Disease
(Outcome)
_
+

+
Exposure
(Risk Factor) _
 Things to consider when designing a
cross-sectional study (survey)

u What is your research question?

u Is the design appropriate for your study?
u Who are you going to study?
u How are you going to obtain your sample?
u Everyone who is eligible should have an equal chance of
being invited to take part
u Is there a risk of selection bias?
u E.g. taking people attending a specialist clinic; might not be
representative of all patients with that condition
u Selection bias is a threat
u How you will collect your exposure/outcome data
u Think about analysis (proportion %, denominator)
 Things to consider when designing a
cross-sectional study (survey)
u The problem to be studied must be clearly
described and a thorough literature review
undertaken before starting the data collection.
u Specific objectives need to be formulated.
u The information has to be collected and data
collection techniques need to be decided.
u Sampling is a particularly important issue to
ensure that the objectives can be met in the
most efficient way.
 Things to consider when designing a
cross-sectional study (survey)
u In Cross-sectional studies think of:
u Sampling Procedures.
u Clear definition of Target Population.
u Clear definition of outcome.
u Clear definition of risk factors.
u Remember Confounders.
 Basic Design

u Cross-sectional study involves no follow-up of individuals, so

are often grouped together
u In addition, this study depends on a full accounting or random
cross-section of the population
u This design is capable of measuring prevalences and open
population incidence rates:
Prevalence or rate,
group 1

Random sample of Prevalence or rate,

Compare
population divided group 2 prevalence or rates
into exposure groups :
:
Prevalence or rate,
group k
 ANALISIS YANG DILAKUKAN DAPAT BERSIFAT:

DESKRIPTIF :
distribusi frekwensi kejadian penyakit/ masalah kesehatan
berdasarkan orang - tempat - waktu

distribusi frekwensi variabel exposure dan outcome

(angka prevalens)

ANALITIK : melihat korelasi/hubungan antara variabel-variabel

diteliti
DESCTIPTIVE CROSS SECTIONAL
STUDIES
Descriptive cross-sectional
(Studi prevalens, Prevalens survei)

Jumlah?
Umur?
Sex?
Pendidikan?
Pekerjaan?
Status penyakit X?
Status variabel Y?
 Analysis

u Standard descriptive statistics can then be

used: mean, median, quartiles, and mode;
measure of dispersion or variability such as
: standard deviation; measure precision
such as: standard error, and confidence
intervals.
u Mean can be compared using t-tests or
analysis of variance (ANOVA).
u More complex multivariate analysis can be
carried out such as multiple and logistic
regression.
 Analysis

u Descriptive analyses
u Analysis of differences
u Analysis of association / relationship
u Multivariable analysis
 Measures of Disease Association

u Measuring occurrence of new outcome events

can be an aim by itself, but usually we want to
look at the relationship between an exposure
(risk factor, predictor) and the outcome

u The type of measure showing an association

between an exposure and an outcome event is
linked to the study design
 Measures of Association in a
Cross-Sectional Study
u Simplest case is to have a dichotomous
outcome and dichotomous exposure variable
u Everyone in the sample is classified as
diseased or not and having the exposure or
not, making a 2 x 2 table
u The proportions with disease are compared
among those with and without the exposure
u NB: Exposure=risk factor=predictor
 Cross-Sectional Study

Obese subjects are two

times more likely to have
osteoarthritis of the knee
than non-obese subjects.
 Cross-Sectional Study
Chicken or egg dilemma
What came first?
Obesity or Osteoarthritis
 Cross-Sectional Studies
CHD No CHD
Cholesterol

High 100 400

Normal/
Low 50 450

100 / (100 + 400) 0.2

Prevalence Ratio = --------------------- = ---- = 2.0
50 / (50 + 450) 0.1
 Cross-Sectional Studies
100 / (100 + 400) 0.2
Prevalence Ratio = --------------------- = ---- = 2.0
50 / (50 + 450) 0.1

Interpretation: In this study population, the

prevalence of CHD is 2 times higher among
those with high cholesterol, compared to the
prevalence in those with normal or low
cholesterol.
Cross sectional design study 1

Begin with
Defined Population

Gather data on exposure and disease

Exposed, Not Exposed,

Exposed, Not Exposed,
Do not have Do not have
Have disease Have disease
disease disease
Contoh :
dalam suatu penelitian dengan disain potong lintang
ingin melihat hubungan antara merokok dan bronchitis kronis
.
D = bronchitis kronis (data kategorikal)
E = merokok (data kategorikal)
pengukuran D dan E dilakukan secara simultan

populasi merupakan pegawai di pabrik A

sampel 1000 orang yang diambil secara random dari populasi

analisis deskriptif : menghitung distribusi frekwensi D dan E

analisis analitik :
analisis khi kuadrat dengan tabel kontingensi
alpha ditentukan 0,05
untuk melihat hubungan E dan D hitung OR atau PR
Tabel kontingensi 2x2 untuk data diatas

Outcome
D+ D- total

E+ 200 200 400

exposure
E- 100 500 600

total 300 700 1000

 Populasi sampel dipilih secara random (acak)
sampel representatif untuk populasi

sampel

distribusi frekwensi variabel exposure

sampel distribusi frekwensi variabel outcome

Distribusi frekwensi berdasarkan variabel exposure pada sampel

terpapar dengan exposure E +
tidak terpapar dengan exposure E

misal sampel terdiri dari 1000 orang

terpapar dengan exposure E + = 400 orang = 40%
tidak terpapar dengan exposure E - = 600 orang = 60%

E+ 40%
prevalensi terpapar dengan exposure = 40%
E- 60% prevalensi tidak terpapar dengan exposure = 60%
Distribusi frekwensi berdasarkan variabel outcome pada sampel
outcome positif D (disease) +
outcomenegatif D (disease)

misal sampel terdiri dari 1000 orang

outcome positif D (disease) + = 300 orang = 30 %
outcomenegatif D (disease) - = 700 orang = 70%
D+ 30%

D- 70%
Prevalensi disease = 30%
prevalensi not disease = 70%
Prevalence ratio of disease in exposed and unexposed
Disease
Yes No

Yes a b a
a+b
PR =
c
No
c d c+d

So a/a+b and c/c+d = probabilities of disease

and PR is ratio of two probabilities
 Prevalence ratio of disease in exposed and unexposed

Mendistribusikan variabel disease pada variabel exposure

200 D+ 100 D+
dari 400(E+) dari 600 (E-)
200 D - 500 D -

E+ 200 D+ 200 D -
E- 100 D+ 500 D -

dari 400 orang (E+) prevalens D+ pada kelompok E+ = 200/400

dari 600 orang (E-) prevalens D - pada kelompok E - = 100/600

prevalens D+ pada kelompok E+ = 200/400

Prevalens Ratio = ------------------------------------------------------------------ = 3
prevalens D + pada kelompok E- = 100/600
Odds D+E + (kelompok orang terpapar) = 200/200
Odds D+E - (kelompok tidaterpapar) = 100/500

Odds D+E + (kelompok orang terpapar) 200/200

OR = ---------------------------------------------------- = ------------ = 5
Odds D+E - (kelompok tidaterpapar) = 100/500
Tabel kontingensi 2x2 untuk data diatas

Outcome
D+ D- total

E+ 200 200 400

exposure
E- 100 500 600

total 300 700 1000

Prevalence ratio of exposure in disease and nondisease
Disease
Yes No

Yes a b a
a+c
PR =
b
No c d b+d

So a/a+c and b/b+d = probabilities of exposure

and PR is ratio of two probabilities
Prevalence ratio of exposure in disease and non disease

Mendistribusikan variabel exposure pada variabel disease

200 E+ 200 E+
dari 300 (D+) dari 700 (D-)
100 E - 500 E -

Prevalens E+D + (kelompok orang sakit) = 200/300

Prevalens E+D - (kelompok tidak sakit) = 200/700

Prevalens E+D + (kelompok orang sakit) 200/300

Prevalens Ratio = ---------------------------------------------------= ------------ = 2 1/3
Prevalens E+D - (kelompok tidak sakit) 200/700
 Odds E+D + (kelompok orang sakit) = 200/100
Odds E+D - (kelompok tidak sakit) = 200/500

Odds E+D + (kelompok orang sakit) = 200/100

OR = ------------------------------------------------------------------ = 5
Odds E+D - (kelompok tidak sakit) = 200/500

Terlihat bahwa kalkulasi nilai OR tetap = 5.

bila variabel disease didistribusikan pada variabel exposure

atau bila variabel exposure dididtribusikan pada variabel disease

Kelebihan Studi Potong Lintang :

dapat untuk melihat distribusi frekwensi penyakit di

populasi

dapat untuk melihat hubungan variabel exposure

dan variabel outcome

hasil analisisnya dapat dipakai untuk membangun

hipotesis baru

Kelemahan Studi Potong Lintang

tidak dapat untuk melihat hubungan sebab akibat,
karena variabel exposure dan variabel outcome
diukur secara simultan
 Advantages
Quick, cheap
Easy to obtain prevalence
Outcome
Exposure
Can adapt design
Case-control study
Prospective cohort study
 Disadvantages
Prone to selection bias
Recall bias
Cannot measure disease onset
Problem of temporality (not a
problem if exposure is constant)
Not suitable for rare disease
TERIMA KASIH