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    Cohort Study

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    This document discusses cohort studies in epidemiology. It defines a cohort study as one that examines the distribution and determinants of health outcomes in populations defined by the presence or absence of a suspected risk factor or cause. It notes that cohort studies are longitudinal and prospective in design. They measure disease incidence by following populations over time, allowing determination of whether an exposure preceded an outcome. The document outlines key elements of cohort studies such as selection of study populations, assessment of exposures, selection of comparison groups, follow-up of participants, and analysis of incidence rates and risk estimates.

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    Cohort Study

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    pewpewpies
    145 views28 pages
    This document discusses cohort studies in epidemiology. It defines a cohort study as one that examines the distribution and determinants of health outcomes in populations defined by the presence or absence of a suspected risk factor or cause. It notes that cohort studies are longitudinal and prospective in design. They measure disease incidence by following populations over time, allowing determination of whether an exposure preceded an outcome. The document outlines key elements of cohort studies such as selection of study populations, assessment of exposures, selection of comparison groups, follow-up of participants, and analysis of incidence rates and risk estimates.

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    This document discusses cohort studies in epidemiology. It defines a cohort study as one that examines the distribution and determinants of health outcomes in populations defined by the presence or absence of a suspected risk factor or cause. It notes that cohort studies are longitudinal and prospective in design. They measure disease incidence by following populations over time, allowing determination of whether an exposure preceded an outcome. The document outlines key elements of cohort studies such as selection of study populations, assessment of exposures, selection of comparison groups, follow-up of participants, and analysis of incidence rates and risk estimates.

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    © All Rights Reserved
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    145 views28 pages

    Cohort Study

    Uploaded by

    pewpewpies
    This document discusses cohort studies in epidemiology. It defines a cohort study as one that examines the distribution and determinants of health outcomes in populations defined by the presence or absence of a suspected risk factor or cause. It notes that cohort studies are longitudinal and prospective in design. They measure disease incidence by following populations over time, allowing determination of whether an exposure preceded an outcome. The document outlines key elements of cohort studies such as selection of study populations, assessment of exposures, selection of comparison groups, follow-up of participants, and analysis of incidence rates and risk estimates.

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    of 28

    COHORT STUDY

    Dr Debadatta Chakrabarty
    Epidemiology
    Defined by John M. Last in 1988
     “Study of Distribution and Determinants of
    health related state or event in a specified
    population and the application of this
    study to the control of health problem”.
     We measure –
     Disease frequency
     Diseases distribution
     Determinants of disease.
    TYPES OF EPIDEMIOLOGICAL STUDIES
    1. OBSERVATIONAL STUDIES
    A. DESCRIPTIVE STUDY
    DESCRIBE DIESEASE BY
    TIME
    PLACE
    PERSON
    B. ANALYTICAL STUDIES
    ECOLOGICAL STUDY
    CROSS SECTIONAL STUDY
    CASE-CONTROL STUDY
    COHORT STUDY
    2. EXPEREMENTAL STUDIES
    RANDOMIZED CONTROLLED TRIAL (RCT)
    FIELD TRIAL
    COMMUNITY TRIAL
    Descriptive Epidemiology
     Describe the disease by
     Time
     Place
     Person
    •Cohort study is undertaken to support the
    existence of association between suspected
    cause and disease
     A major limitation of cross-sectional surveys and
    case-control studies is difficulty in determining if
    exposure or risk factor preceded the disease or
    outcome.
     Cohort Study:

    Key Point:

     Presence or absence of risk factor is


    determined before outcome occurs.
    WHAT IS COHORT
     Ancient Roman
    military unit, A band
    of warriors.
     Persons banded
    together.
     Group of persons with
    a common statistical
    characteristic. [Latin]
     E.g. age, birth date,
    Cohort studies
     longitudinal
     Prospective studies
     Forward looking study
     Incidence study

     starts with people free of disease


     assesses exposure at “baseline”
     assesses disease status at “follow-up”
    INDICATION OF A COHORT STUDY
     When there is good evidence of exposure
    and disease.
     When exposure is rare but incidence of
    disease is higher among exposed
     When follow-up is easy, cohort is stable
     When ample funds are available
    Frame work of Cohort studies
    Disease Status
    Total Yes No

    Study
    Exposure
    Yes a+b a b cohort

    Status
    No Comparison
    c+d c d cohort

    N a+c b+d
    General consideration while selection
    of cohorts
     Both the cohorts are free of the disease.
     Both the groups should equally susceptible
    to disease
     Both the groups should be comparable
     Diagnostic and eligibility criteria for the
    disease should be defined well in advance.
    Elements of cohort study
     Selection of study subjects
     Obtaining data on exposure
     Selection of comparison group
     Follow up
     Analysis
    Selection of study subjects
     General population
     Whole population in an area
     A representative sample
     Special group of population
     Select group
     occupation group / professional group (Dolls study )
     Exposure groups
     Person having exposure to some physical, chemical or
    biological agent
     e.g. X-ray exposure to radiologists
    Obtaining data on exposure
     Personal interviews / mailed questionnaire
     Reviews of records
     Dose of drug, radiation, type of surgery etc
     Medical examination or special test
     Blood pressure, serum cholesterol
     Environmental survey

     By obtaining the data of exposure we can


    classify cohorts as
     Exposed and non exposed and
     By degree exposure we can sub classify cohorts
    Selection of comparison group
     Internal comparison
     Only one cohort involved in study
     Sub classified and internal comparison done
     External comparison
     More than one cohort in the study for the purpose of
    comparison
     e.g. Cohort of radiologist compared with
    ophthalmologists
     Comparison with general population rates
     If no comparison group is available we can compare
    the rates of study cohort with general population.
     Cancer rate of uranium miners with cancer in general
    population
    Follow-up
     To obtain data about outcome to be determined
    (morbidity or death)
     Mailed questionnaire, telephone calls, personal
    interviews
     Periodic medical examination
     Reviewing records
     Surveillance of death records
     Follow up is the most critical part of the study
     Some loss to follow up is inevitable due to death
    change of address, migration, change of
    occupation.
     Loss to follow-up is one of the draw-back of the
    cohort study.
    ANALYSIS

     Calculation of incidence rates among


    exposed and non exposed groups

     Estimation of risk
    Incidence rates of outcome
    Disease Status
    Yes No Total

    Study
    Exposure
    Yes a b a+b cohort

    Status
    No Comparison
    c d c+d cohort

    a+c b+d N
    Incidence rate
     Incidence among exposed =
    a
    a+b
     Incidence among non-exposed =
    c
    c+d
    Estimation of risk
    Relative Risk
    incidence of disease among exposed
    RR = ______________________________
    Incidence of disease among non-exposed
    a/a+b
    = _________
    c/c+d
    Estimation of Risk
    Attributable Risk
    Incidence of disease among exposed –
    incidence of disease among non exposed
    AR = _______________________________
    Incidence of disease among exposed
    a/a+b – c/c+d
    AR = _______________
    a/a+b
    Smoking Lung cancer Total

    YES NO

    YES 70 6930 7000

    NO 3 2997 3000

    73 9927 10000

    Find out RR and AR for above data


     Incidence of lung cancer among smokers
    70/7000 = 10 per 1000
     Incidence of lung cancer among non-smokers
    3/3000 = 1 per thousand
    RR = 10 / 1 = 10
    (lung cancer is 10 times more common among
    smokers than non smokers)
    AR = 10 – 1 / 10 X 100
    = 90 %
    (90% of the cases of lung cancer among
    smokers are attributed to their habit of smoking)
    Types of Cohort Study
     Prospective cohort study
     Retrospective (historical) cohort study
     Combination of Retrospective and
    Prospective cohort study.
    Cohort studies
    Strengths
    Weaknesses
     We can find out
    incidence rate and  losses to follow-up
    risk  often requires large
     More than one sample
    disease related to  ineffective for rare
    single exposure diseases
     can establish cause -  long time to complete
    effect
     good when exposure
     expensive
    is rare  Ethical issues
     minimizes selection
    and information bias
    THANK YOU

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