Descriptive study designs

1. Characteristic and purpose

mainly concerned with the distribution.

useful for allocation of resources.
important for hypothesis generation.
less time consuming and less expensive.
Are commonly used .
2. Types of descriptive study designs
Case report
Case series
Ecological
Cross sectional
2.1 Case report and case series
case reports describe the experience of a single patient
case series describe the experience of a group of patients
with similar diagnosis
both document unusual occurrences
Example of case series
• In 1974, Creech and Johnson reported a case series of
three men with angiosarcoma of the liver among workers
at a vinyl chloride plant.
• This number in such a small population during the time
period studied was clearly in excess of what was
expected
• this led to the formulation of the hypothesis that
occupational exposure to vinyl chloride caused hepatic
angiosacrcoma.
• Later the same year, this hypothesis was substantiated by
data from two analytic studies
Limitations of case report/series

The presence of any risk factor may be coincidental

interpretation of information from case series is
severely limited by the lack of an appropriate
comparison group
 
2.2. Cross sectional surveys

often called prevalence studies

Exposure and disease status are assessed
simultaneously
help in assessing the health status and health care
needs of a population
Several countries conduct regular cross-sectional
surveys on representative samples of their population.
Advantages of cross sectional studies:

one-stop, one-time collection of data

less expensive & easier to conduct
provide much information useful for planning
health services and medical programs
show relative distribution of conditions, disease,
injury and disability in groups and populations
studies are based on a sample - do not rely on
individuals that present themselves for medical
treatment
Disadvantages of cross-sectional studies

1) chicken or egg dilemma -which occurred first? the

exposure or the outcome ?
Example: study conducted to explore relationship b/n
physical activity & Coronary Heart Disease (CHD)
-investigators compared the prevalence rates of CHD
among white farm owners who did and did not do their
own labor.
Disadvantages cont..
Result: prevalence rates among those who were not
physically active in their work was nearly 5 times
higher than that among those who engaged in farm
labor.
But it is impossible to determine from this finding
whether physical activity is truly protective or whether
farmers with symptoms of CHD are simply more
likely to decrease their physical labor.
Disadvantages cont..
Cross sectional studies can reveal valid association
only when the current values of the exposure variables
are unalterable over time
Such variables include factors present at birth, such as
blood group.
2) It may not show strong cause-effect relationships if
sample size is small.
Analysis

 Either compare prevalence rate of the outcome in exposed Vs non-

exposed, or
 Compare prevalence rate of the exposure in those with and without
the outcome
 timing of the subdivision of the study population into comparison
groups distinguishes cross sectional studies from other observational
analytic studies
 In cohort and case control studies, this takes place prior to the data
collection process
 In a cross sectional study, this takes place after the information has
been collected
 2.3 Correlational (Ecological) studies

measures that represent characteristics of entire

population are used to describe disease in relation to
some factor of interest
The units of analysis are populations or groups of
people rather than individuals
compare populations in different countries at the same
time or the same population of a country at different
times
Example of correlational study
to describe patterns of mortality from CHD in 1960,
death rates from 44 states were correlated with
percapita cigarette sales.
Death rates were highest in states with the most
cigarette sales
This contributed to the formulation of the hypothesis
that cigarette smoking causes fatal CHD
This has been substantiated in a large number of
subsequent analytic epidemiologic studies.
 Strengths and Limitations of correlational
studies
Strength
can be done quickly and inexpensively, often using
already available information
Limitation
1) Since the unit of analysis is a population or group, the
individual link between exposure and effect cannot be
made
Limitations of correlational studies cont..
2) lack of ability to control for the effects of potential
confounding factors
3) correlational data represent average exposure levels
rather than actual individual values.
This may lead to - Ecological fallacy- the association
observed between variables at the group level does not
necessarily represent the association that exists at
individual level
3. Hypothesis formulation from descriptive
studies

1. Method of difference
 if the frequency of disease is markedly different in 2
sets of circumstances, the disease may be caused by
some particular factor that differs between them
Example, the observation that certain cancers are very
rare in one country but very common in another
became part of the basis for the current belief in the
avoidability of a large proportion of human cancers by
manipulation of environment or life-style variables
Hypothesis formulation from descriptive studies
cont..

2)Method of agreement
Refers to the observation that a single factor is common to
a number of circumstances in which a disease occurs with
high frequency.
Example: in AIDS, the unusually high frequency among iv
drug abusers, recipients of transfusions, and hemophiliacs
raised the possibility that one mode of transmission
involved introduction of the virus in to the blood stream
 Hypothesis formulation from descriptive studies cont…

3) Method of concomitant variation

refers to circumstances in which the frequency of a factor
varies in proportion to the frequency of disease.
Correlational studies are particularly useful sources of
data for this type of hypothesis formulation
E.g CHD mortality rates rise with per capita cigarette
consumption.