Cohort Study

Dr Waqar Ali
Associate Professor
PhD Scholar, MBBS, MPH(Pak),MNCH (Pak), QMIH(Germany), HRHM (U.K)
Objectives

By the end of the session the learner would be able to understand:

1. Types of Cohort Studies
2. Relative risk
3. Difference between prospective and retrospective cohort studies
4. Potential Biases of Cohort Studies
What is Incidence?
WHAT IS A COHORT?
• Cohort is a group having a common characteristic.

• e.g. A smoker’s cohort means all are smokers in that group.

• Cohort study is carry out to support the presence of association

between suspected cause and disease
It is also known as:
• longitudinal
• Prospective studies
• Forward looking study
• Incidence study

• Starts With People Free Of Disease

• Assesses Exposure At “Baseline”
• Assesses disease status at “follow-up”
Design Of A Cohort Study
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Excess Risk Can Be Calculated In The Two
Following Ways

1. The ratio of the incidence rates

Disease risk(incidence) in exposed
Disease risk(incidence) in non-exposed
This ratio is called the relative risk also know as risk ratio

2. The difference in the incidence rates

(Disease risk in exposed) – (Disease risk in non-exposed)
This difference is called the attributable risk
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OR?
 Incidence?

Relative risk?

Interpretation:
• In this study the individuals who smoked had 1.61 times the risk of
coronary heart disease as compared to the individuals who did not smoke
Poll
Exercise
A public health physician wants to study the prevalence/burden of
hypertension in Rawalpindi district to establish special screening &
treatment services. In the mentioned area which design is more useful
for this?
a) Cross sectional
b) Case series
c) Cohort
d) Case control
e) Experimental
 Types of Cohort Studies
1. Prospective Cohort Study (concurrent or longitudinal).

2. Retrospective Cohort Study (historical cohort or non-concurrent

prospective study).
Before any of the subjects have developed any of the outcomes of interest.
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The designs for both are identical:
We are comparing exposed and non exposed populations
Advantages
Prospective cohort studies:
•Provide better information on exposures.
•Are less vulnerable to bias because exposure
status is determined before outcomes.

Retrospective cohort studies:

•Efficient for diseases with long latent period
(time from exposure to development of
disease).
Disadvantages
Prospective Cohort Study
• May need large numbers of subjects for long
periods of time.
• Can be expensive and time consuming.
• Inefficient for diseases with long latent periods.
• Loss to follow up can bias results.

Retrospective Cohort Study

• Poor information on exposures
• More vulnerable to bias.
Example of a Prospective Cohort Study:
Framingham Study

Poll (2)
The physical examination records of the entire incoming
freshman class of 1935 at the University of Minnesota were
examined in 1977 to see if their recorded height and weight at
the time of admission to the university was related to the
development of coronary heart disease by 1986. This is an
example of:
a. A cross-sectional study
b. A case-control study
c. A prospective cohort study
d. A retrospective cohort study
e. An experimental study
Exercise
2. The smoking history of pregnant women is taken in the antenatal
period and correlated with the birth weight at the time of delivery. To
find an association between them would be an example of:
a. Clinical trial
b. Nested cohort study
c. Retrospective study
d. Prospective study
e. Cross sectional study
Cohort Studies For Investigating
Childhood Health And Disease

• A particularly interesting use of the cohort design is for long-term

cohort studies of childhood health and disease.

• Experiences and exposures during fetal life may have long-lasting

effects, even into adult life.
POTENTIAL BIASES IN COHORT
STUDIES
1. Bias In Assessment Of The Outcome
2. Information Bias
3. Biases From Nonresponse And Losses To Follow-up
4. Analytic Bias
Advantages of Cohort Studies
• Temporal sequence between exposure & disease is clear (e.g., obesity
preceded CHD)

• Efficient for looking at rare exposures or unusual risk factors (e.g. agent orange).

• Can evaluate multiple effects of a single exposure.

Exercise
3. A doctor is required to study the incidence of silicosis in a stone cutting
industry, which study design should he choose:
a. Longitudinal
b. Cross-sectional
c. Ecological surveys
d. Case reports
e. Case series report

4. Can you can estimate prevalence from a cohort study?

i. Yes
ii. No
Ask any 2 questions
Homework
• Advantages and Disadvantages of Cohort studies
• Difference between Cohort and Case Control study
(identify 2 mistakes)

• K Park
Reference
• Leon Gordis 6th Edition
• K Parks 24th Edition

33
Thank You