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    Hierarchy of Epidemiologic Study Design: Tower & Spector, 2007

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    Aslam Bajwa
    The document discusses different epidemiological study designs including case-control studies, cohort studies, and experimental studies such as randomized controlled trials. Case-control studies examine the association between exposures and outcomes by comparing exposed and unexposed groups. Cohort studies follow groups over time to compare incidence of disease between exposed and unexposed individuals. Experimental studies use randomization and control groups to test causal relationships.

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    Hierarchy of Epidemiologic Study Design: Tower & Spector, 2007

    Uploaded by

    Aslam Bajwa
    130 views42 pages
    The document discusses different epidemiological study designs including case-control studies, cohort studies, and experimental studies such as randomized controlled trials. Case-control studies examine the association between exposures and outcomes by comparing exposed and unexposed groups. Cohort studies follow groups over time to compare incidence of disease between exposed and unexposed individuals. Experimental studies use randomization and control groups to test causal relationships.

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    Presentation epidemiology

    Original Title

    Analytical Epidemiology

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    The document discusses different epidemiological study designs including case-control studies, cohort studies, and experimental studies such as randomized controlled trials. Case-control studies examine the association between exposures and outcomes by comparing exposed and unexposed groups. Cohort studies follow groups over time to compare incidence of disease between exposed and unexposed individuals. Experimental studies use randomization and control groups to test causal relationships.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    130 views42 pages

    Hierarchy of Epidemiologic Study Design: Tower & Spector, 2007

    Uploaded by

    Aslam Bajwa
    The document discusses different epidemiological study designs including case-control studies, cohort studies, and experimental studies such as randomized controlled trials. Case-control studies examine the association between exposures and outcomes by comparing exposed and unexposed groups. Cohort studies follow groups over time to compare incidence of disease between exposed and unexposed individuals. Experimental studies use randomization and control groups to test causal relationships.

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 42

    Hierarchy of Epidemiologic Study Design

    Tower & Spector, 2007 (www)


    Epidemiologic Study Designs

    Grimes & Schulz, 2002 (www)


    Epidemiologic Study Designs

    Grimes & Schulz, 2002 (www)


    Case-Control Studies

    Exposed
    Not
    Cases
    exposed
    Population
    Exposed Controls
    Not
    exposed
    Case-Control Studies

    Schulz & Grimes, 2002 (www) (PDF)


    Cause-and-Effect
    Relationship

    Grimes & Schulz, 2002 (www) (PDF)


    Epidemiologic Association / Impact Measures

    Relative Risk (Risk Ratio) (RR)

    Odds Ratio (OR)

    Attributable Risk (AR)

    Relative Risk Reduction (RRR)

    Measures of test accuracy:

    Sensitivity, specificity, positive and negative predictive value


    (PPV, NPV)
    Advantages of Case-Control Studies

    - Cheap, easy and quick studies


    - Multiple exposures can be examined
    - Rare diseases and diseases with long latency
    can be studied
    - Suitable when randomization is unethical
    (alcohol and pregnancy outcome)
    Disadvantages of Case-Control Studies

    - Case and control selection troublesome


    - Subject to bias (selection, recall, misclassification)
    - Direct incidence estimation is not possible
    - Temporal relationship is not clear
    - Multiple outcomes cannot be studied
    - If the incidence of exposure is high, it is difficult to show the
    difference between cases and controls
    - Not easy to estimate attributable fraction
    - Reverse causation is a problem in interpretation - especially
    in molecular epidemiology studies
    Hierarchy of Epidemiologic Study Design

    Tower & Spector, 2007 (www)


    Epidemiologic Study Designs

    Grimes & Schulz, 2002 (www)


    Epidemiologic Study Designs

    Grimes & Schulz, 2002 (www)


    Cohort Studies

    Disease
    People Exposed No disease
    Population without
    disease Not Disease
    exposed
    No disease
    Cohort Studies

    Grimes & Schulz, 2002 (www) (PDF)


    Examples of Cohort Studies

    * Framingham Heart Study (www)


    * NHANES Studies (www)
    * MACS (www)
    * Physicians' Health Study (www)
    * Nurses' Health Study (www)
    * ALSPAC (www)
    COHORT
    A Group of People which who share a
    common characteristic or experience with in
    a define time period e.g. Age, Occupation,
    Exposure to a drug, Pregnancy, Insurance
    etc.

    Birth Cohort
    Exposure Cohort
    Marriage Cohort
    Indications for Cohort Study
    When There is good evidence of an Association
    between exposure and disease, as derived from
    clinical observation and supportive by descriptive
    and case control studies
    When exposure is rare but the incidence of disease
    is high among exposed e.g. Special exposure
    groups like those in industries

    When attritions of study population can be


    minimised e.g. Follow up is easy cohort is stable

    When ample funds are available


    Elements of Cohort Study

    Selection of Study Subjects

    Obtaining Data on exposure

    Selection of Comparison Group

    Follow up

    Analysis
    Analysis of Cohort Study

    Relative Risk
    Incidence of Disease (or Death) among Exposed
    RR =
    Incidence of Disease (or Death) among Non
    Exposed
    Attributable risk
    Incidence of Disease rate among Exposed Incidence
    of Disease rate among Non Exposed
    X 100
    Incidence of Disease rate among Exposed

    Population Attributable Risk


    Incidence of Disease in the total population Incidence
    of Disease among those who were not Exposed
    Presentation of cohort data:
    Population at risk

    Does HIV infection increase risk of developing TB


    among a population of drug users?

    Population Cases
    (follow up 2 years)

    HIV + 215 8
    HIV - 289 1

    Source: Selwyn et al., New York, 1989


    EPIET (www)
    Does HIV infection increase risk of developing TB
    among drug users?

    Population Incidence Relative


    Exposure Cases
    (f/u 2 years) (%) Risk

    HIV + 215 8 3.7 11

    HIV - 298 1 0.3

    EPIET (www)
    Advantages of Cohort Studies

    - Can establish population-based incidence


    - Accurate relative risk (risk ratio) estimation
    - Can examine rare exposures (asbestos > lung cancer)
    - Temporal relationship can be inferred (prospective design)
    - Time-to-event analysis is possible
    - Can be used where randomization is not possible
    - Magnitude of a risk factor’s effect can be quantified
    - Selection and information biases are decreased
    - Multiple outcomes can be studied
    (smoking > lung cancer, COPD, larynx cancer)
    Disadvantages of Cohort Studies

    - Lengthy and expensive


    - May require very large samples
    - Not suitable for rare diseases
    - Not suitable for diseases with long-latency
    - Unexpected environmental changes may influence the association
    - Nonresponse, migration and loss-to-follow-up biases
    - Sampling, ascertainment and observer biases are still possible
    Hierarchy of Epidemiologic Study Design

    Tower & Spector, 2007 (www)


    Epidemiologic Study Designs

    Grimes & Schulz, 2002 (www)


    Experimental Studies

    • Animal Studies

    • Human Experiments

    • Randomized Controlled Trials

    • Non Randomized Controlled Trials


    Steps in Conducting RCT
    • Drawing up a Protocol
    • Selecting Reference and Experimental Population
    • Randomization
    • Manipulation or Intervention
    • Follow up
    • Assessment of outcome
    RCT, Bias and Blinding
    Single Blind Double Blind Triple Blind
    Types of RCT
    • Clinical Trials
    • Preventive Trials
    • Risk Factor Trials
    • Cessation Experiment
    • Trial of Aetiological Agent
    • Evaluation of Health Services

    Types of Non Randomized Controlled Trials


    Uncontrolled Natural Before and After
    Trials Experiments Comparison

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