Case-Cohort Study

Case-Cohort Study

• Innovative and Hybrid design

• Uses a sub-sampling technique in survival data for estimating the
relative risk of disease in a cohort study without collecting data from
the entire cohort
• Originally designed to allow efficient analysis of studies where the
population size was too large to collect detailed data on allthe
participants, e.g. large survey studies
Prentice R.L., “A case-cohort design for epidemiologic cohort studies and disease
prevention trials” Biometrika: 73(1), 1986 pgs 1-11.

7 2
• Randomly selecting a subcohort from the original sample at entry and
only analyzing data on members of the subcohort and all cases

• Raw data is collected on all subjects, but the data would only be analyzed
on cases and subcohort members

2/2017 3
• Ex: blood samples would be collected over time for all study
participants and frozen for storage. Then, the biochemical analysis for
specific covariates would only be performed on participants in the
randomly selected subcohort or subjects that developed the disease of
interest

4
 Cohort Study
Disease/Outcome/Dependent
Variable
GMI (+) GMI (-) Total
Exposure/ Empa 117 (a) 1859 (b) 1976 (a+b)
Intervention
/ Risk factor/ Placebo 15 (c) 980 (d) 995 (c+d)
Independent Total 132 (a+c) 2839 2971
variable (b+d)

10 Years

a/a+b 117/1976
RR = c/c+d RR = 15/995
5
 Case-Cohort Study
In a case-cohort study - in a cohort with complete follow-
up, all of the cases and a sample, r, of the cohort are used
Ex: r = 70% of cohort
Disease/Outcome/Dependent Variable
GMI (+) GMI (-) Total

Exposure/ Empa 117 (a) 1859 (b) 1976 (a+b) (r)

Intervention
/ Risk factor/ Placebo 15 (c) 980 (d) 995 (c+d) (r)
Independent
variable Total 132 (a+c) 2839 (b+d) 2971

a/a+b 117/1383
RR = c/c+d RR = 15/697
6
 Advantages

Similar to nested case-control study design:

• Efficient– not all members of parent cohort require diagnostic testing
• Flexible– allows testing hypotheses not anticipated when the cohort was
drawn (t0)
• Reduces selection bias – cases and noncases sampled from same population
• Reduced information bias – risk factor exposure can be assessed with
investigator blind to case status

17 7
Other advantages, as compared to nested case-
control study design:
• The subcohort can be used to study multiple
outcomes
• Risk can be measured at any time up to t1
• Subcohort can be used to calculate person- time
risk

7 8
• Disadvantages
as compared to nested case-control study
design:
• Increased potential for information bias because
 subcohort may have been established after t0
 exposure information collected at different times (e.g. potential
for sample deterioration)

17 9
THANK YOU