Analytical studies

Analytical studies
The

subject of interest is the individual within the population. The object is not to formulate but to test hypothesis. There are two types of studies : Case control study Cohort study

Case control study (retrospective)

1. 2. 3.

To test causal hypothesis. There are three distinct features :Both exposure and outcome have occurred before the start of the study Study proceed from effect to cause Uses a control group to support

Contd

1. 2. 3. 4.

This is basically comparison study. The case and control are compared on the basis of factors such as age, sex, occupation, social status. The basic steps are :Selection of cases and controls Matching Measurement of exposure Analysis and interpretation

Selection of cases
1. 2. 1. 2.

Definition of case : Diagnostic criteria Eligibility criteria (new cases or old cases) Source of cases : Hospitals General population

Selection of controls
Comparison

group is selected before study is done, who have not been exposed to disease or some other factor Source of controls : the possible sources are hospitals, relatives, neighbors and general population

Matching
It

is defined as the process by which be select controls in such a way that they are similar to cases with regard to certain selected variables.

Measureent of exposure
Information

about exposure should be obtained in precisely the same manner both for cases and controls. This may be obtained by studying past records, hospital records, employment records, interview, by questionnarie.

Analysis
The final step is analysis to find out : 1. Exposure rates among cases and controls to suspected factor 2. Estimation of disease risk associated with exposure

Exposure rates
Suspected or risk factors Present Absent Exposure rates cases a c a/ (a + c) controls b d b/ (b + d)

Estimation of risk
The

exposure rate doesnt mean that the whole population is at risk of disease condition. risk = incidence among exposed/ incidence among non exposed

Relative

Cohort study
This

is usually undertaken to obtain additional evidence to support the existence of an association between suspected cause and disease. The distinguisng features are : The identification prior to appearance of disease Group is observed a period of time and determine frequency of disease.

Contd

The term cohort is defined as a group of people who share a common characteristic or experience within defined period of time. General considerations : The cohort must free from disease under study. Both the groups should be comparable in respect of all the possible variables, which may influence the frequency of disease.

Contd..
The

diagnostic and eligibility criteria of the disease must be defined before study. The groups are followed under the same identical conditions, over a period of time to detrmine the outcome of exposure.

Types of cohort studies

Three

types on the basis of the time of occurrence of disease in relation to the time at which the investigation is initiated. Prospective Retrospective Combination of both

Prospective cohort studies

Or

current cohort study is one in which the outcome has not yet occurred at the time the investigation begins. Most prospective studies begin in the present and continue into future. Workers in uranium mines

Retrospective studies
It

is the one in which the outcomes have all occurred before the start of investigation. The investigator goes back in time, sometimes 10-30 years to select his study groups from existing record of past employment, medical or other records.

Elements of cohort study

Selection

of study subjects Obtaining the data on exposure Selection of comparison groups Follow-up Analysis

Selection of study subjects

General

population Special groups

OBTAINING
Cohort

DATA ON EXPOSURE

members Review of records Medical examination Environmental surveys

Selection of comparison groups

Internal

comparisons External comparisons Comparisons with general population rates FOLLOW UP Periodic medical examination Reviewing hospital records Routine surveillance Periodic visits at least 3 annually

Analysis
The

data are analyzed in terms of Estimation of risk Incidence rates of outcome exposed and non exposed

Incidence rates
Cigarette Developed Did not smoking lung cancer develop lung cancer yes no a c b D

Relative Risk
It

is the ratio of the incidence of the disease among exposed and the incidence among non exposed.

Attribute
It

risk

is the difference in incidence rates of disease between exposed group and non exposed group / incidence rate among exposed x 100