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Ivan J Perry Department of Epidemiology & Public Health University College Cork
Scenario
It is suggested that occupational exposure to volatile anaesthetic agents causes depression. You wish to test this hypothesis.
Learning objectives
At the end of this lecture you should be able to:
List and distinguish between the four major types of observational analytical study designs, including the strengths and limitations of each design Understand the difference between prevalence and incidence
Given a research question you should be able to select the appropriate study design
Observational
Descriptive
Analytical
Experimental
Type of Study
Ecological Cross-sectional
Alternative Name
Correlational Prevalence
Unit of Study
Populations Individuals
Case-control
Cohort
Case-reference
Follow-up
Individuals
Individuals
Ecological studies often provide the first tentative evidence of an association between a causal factor and disease The units of analysis are populations or groups of people rather than individuals
Advantages
Ecological studies are simple to conduct, often using pre-existing data collected for other purposes
Data can be used from populations with widely differing characteristics
Disadvantages
Suitable exposure and outcome data may not be available as the data is usually pre-existing
Objectives
To examine health problem or disease frequency
To examine association between the exposure and health problem or disease frequency Unit of analysis is individual Exposure and disease status of individual is assessed at the same time
Prevalence is the number of cases in a defined population at a specified point in time, expressed as a proportion of the total population at risk for the condition. The prevalence rate for a disease is calculated as follows:
P = No. of people with disease at specified time No. of people in population at risk at specified time
60 50 40
% 30
20 10 0 50-54 55-59
Male
60-64
65-69
Female
Advantages
A cross sectional study is short term, easy and economical to conduct
A cross sectional study generally starts with a reference population and is generalisable
Causal inference can be made from cross sectional data, provided it is known that the exposure preceded the effect or disease
Disadvantages
It is not possible to determine in some cases whether the exposure preceded the condition or disease Not suitable for investigation of rare diseases Generally requires large number of subjects The problem of selective survival may be an issue
Type of Study
Ecological Cross-sectional
Alternative Name
Correlational Prevalence
Unit of Study
Populations Individuals
Case-control
Cohort
Case-reference
Follow-up
Individuals
Individuals
Lung cancer patients Controls Total Smokers 647 622 1269 Non-smokers 2 27 29 Total 649 649 1298
Cases
Controls b
Exposed
Not Exposed
OR = a x d b x c
Note: the odds ratio of the Doll & Hill data shows clearly how much smoking increases the risk of lung cancer.
Advantages
Well suited to the study of rare disease Relatively quick and inexpensive to conduct
No loss to follow-up.
Allows study of multiple potential causes of disease
Disadvantages
Relies on record or recall for information on past exposure (potential for recall bias)
Incidence rate
Cumulative Incidence
Relative Risk
Incidence rate (IR)is the number of new cases arising in a given period in a specified population. Incidence can be measured as follows:
IR = No. people who get disease (given time period) Sum of time each person remained under observation and at risk of becoming a case Usually expresses as number of cases per 1000 or per, 100,000 person years of follow-up.
Cumulative Incidence measures the denominator only at the beginning of the study. Cumulative incidence can be measured as follows: No. people who get disease (given time period) CI= No. disease free people in population at risk at the beginning of the period
Usually expresses as % risk during a defined period of follow-up, e.g. over 1 year or 5 years
Ratio Measure
Incidence of disease in exposed Incidence of disease in non-exposed
Note: in case-control studies relative risk is derived indirectly from the odds ratio.
70 65 139 274
Advantages
Suitable for the study of rare exposure Can assess multiple outcomes (effects) of single exposure Can demonstrate temporal relationship between exposure and disease Allows direct measurement of incidence of disease in the exposed and non-exposed population Changes in exposure over time can be studied Recall and selection bias are unlikely
Disadvantages
Not suitable for the study of a rare disease, unless a large sample size is obtained