Observational

and Analytical Studies

GROUP 1
JANE GOD IS ABLE
JECINTA MOKI
JONAH ROBIRO NYACHAE
EMMANUEL KEYA

CONTINOUS ASSESMENT TEST

CLASS PRESENTATION.
On
18TH OCTOBER 2019
Department of Public Health
 Learning Objectives
 Describe the observational study design in epidemiology
 Describe the use of Observational study design in
epidemiology.
 Describe the most appropriate circumstances under which
Observational study design might be used in
epidemiology.
 Describe the Analytical study design.
 Describe the use of Analytical study design in
epidemiology.
 Describe the most appropriate circumstances under which
Analytical study design might be used in epidemiology.

Observational and Analytic

2
Studies
 Observational study design in
epidemiology
 Is a type of correlational (i.E., Non-experimental)
study design
 In which a researcher observes ongoing behavior.
 It is a social study technique that involves the direct
observation of phenomena in their natural setting.
 It is simply studying behaviors that occur naturally in
natural contexts.

(Wayne Martin S, 1987)

Observational and Analytic Studies 3

 The uses of Observational study design
in epidemiology.
 Study designs used in observational epidemiology
include:
 Case reports,
 Cross-sectional studies,
 Case-control studies,
 Cohort studies.
 Studies can be designed to be:
 Retrospective
 Prospective.
 Sampling is a key issue in this study designs.

Observational and Analytic Studies 3

 Use of Observational study design in
epidemiology.
• To determine the degree of associations between
various risk factors and outcomes.
• To assess the prevalence of a disease in a population
• To identify beneficial or harmful exposures/ behaviors.
• To study triggers within an individual/ populations that
influence risk of disease.
• To study rare diseases and outcomes that have long
follow-up periods.
• To learn about the characteristics of a population at one
point in time.
• To determine relative effectiveness of interventions
• Used in public health research.

Observational and Analytic Studies 3

Uses summarized
Provide data regarding:-
•Magnitude of the disease.
•Morbidity &mortality rates.
Provide “clues” to disease etiology.
Helps in:
Formulation of etiological hypothesis.
Planning, implementing & evaluation of
programmes.
 Observational study design uses
Epidemiology.
Case-control studies:
 Used to determine the degree of associations between
various risk factors and outcomes.
 Case-control studies can help identify beneficial or
harmful exposures.
 There are two groups of patients-cases and controls.
 Typically, epidemiologists identify appropriate
representative controls for the cases that they are
studying from the general population.
 Then they retrospectively look in the past for the
possible exposures these patients might have had to a
risk factor

Observational and Analytic Studies 4

 Observational study design uses Epidemiology.

Case control studies.

This study design is especially suitable for rare diseases
that have longer latency periods
Are usually of clinical nature.
oConsiders single/ group of patients with similar symptoms.
oClinician identifies unusual feature of disease and formulate
a hypothesis.
oThey represent important interface between clinical
medicine and epidemiology.
(Myers, 1998)
 Observational study design uses
Epidemiology.
Case series:
 Are collection of individual case reports, may occur
within a fairly short time period.
 They illustrate a new finding.
 emphasize on a clinical principal.
 Its not a measure of disease occurrence.
 Don’t identify risk factor/ cause of diseases

Observational and Analytic Studies 4

 Observational study design uses
Epidemiology.
Ecological( correlational)
 Investigator measures characteristic of entire population to
describe disease in relation to:
i. Age, sex , etc. e.g. Pap smear correlation with mortality
from ca cervix.
 Units of studies are population other than individuals.
 Ecological studies are used when data at an individual
level is unavailable or when large-scale comparisons are
needed
 to study the population-level effect of exposures on a
disease condition.
 Therefore, ecological study results are applicable only at
the population level.
Observational and Analytic Studies 4
 Observational study design uses
Epidemiology.
Cross-sectional studies
 Generally used to assess the prevalence of a
disease in a population
 Exposure and disease are assessed
simultaneously in individuals of well defined
population.
 Give a snapshot of the characteristics of study
subjects in a single point of time.
 Unlike cohort studies, cross-sectional studies do
not have a follow-up period and therefore are
relatively simple to conduct

Observational and Analytic Studies 4

 Analytical study design in
epidemiology.
 The analytical epidemiology aims to gain knowledge on
the quality and the amount of influence that determinants
have on the occurrence of disease.
 The usual way to gain this knowledge is by group
comparisons.
 Such a comparison starts from one or more hypotheses
about how the determinant may influence occurrence of
disease.
 Analytic studies test hypotheses about exposure outcome
relationship.

Observational and Analytic Studies 7

 Analytical study design in
epidemiology.
 Measure the association between exposure and
outcome
 A comparative study design to reach causal
inferences about hypothesized relationships
between risk factor and out come.
 It identifies and quantifies associations.
 It identify causes and determine whether an
association exists between variables such as
exposure and disease.
 Include a comparison group
 Answer why and how

Observational and Analytic Studies 7

 Analytical study design in epidemiology.
 Hypothesis: people who have eaten home preserved
green SALADS in restaurant X in august 2006 have
an increased risk of developing botulism/
gastrointestinal infection than those who have not
eaten such salads.
 A hypothesis is an educated guess about an
association that is testable in a scientific
investigation.
 Hypotheses tend to be broad initially and are then
refined to have a narrower focus

(Rothman KJ, 2008)

Observational and Analytic Studies 7

 The use of Analytical study design in
epidemiology.
 Used in follow up study. Cohort study
What is a cohort? Examples of a Cohort?

 Aims at determining risk factors for disease outcome.

 All persons in cohort must be free of disease to start with.

 At start identify two groups:

1) with exposure to a risk factor (exposed).
2) without exposure to risk(non-exposed)
 Follow the two groups over a period of time.

 After follow up, analyze the disease/outcome, occurrence

in both groups and compare.
Observational and Analytic Studies 7
Cohort Study(longitudinal study, follow-
up study)
 Participants classified according to exposure

 Status and followed-up over time to ascertain

outcome.

 Can be used to find multiple outcomes from a

single exposure.

 Ensures temporality (exposure occurs before

observed outcome).
 Appropriate for rare exposures or defined cohorts
Observational and Analytic Studies 23
 The use of Analytical study design in
epidemiology.
Cohort study types:
1. Prospective (concurrent). Participants are
grouped according to past/current exposure and
followed up into future to determine outcome
2. Retrospective (historical, non-concurrent). At the
time of study exposure an outcomes have
already occurred in the past.
3. Ambidirectional ( data collected both
retrospectively and prospectively).

(Rothman KJ, 2008)

Observational and Analytic Studies 7
 Prospective Cohort Studies
Disease
Exposed
No Disease
Study
Population
Disease
Unexposed
No Disease

Start of
study
(Future)
(Present)
Observational and Analytic Studies 26
 Retrospective Cohort Studies
Disease
Exposed
No Disease
Study
Population
Disease
Unexposed
No Disease

Start of
study
(Past)
(Present)

Observational and Analytic Studies 27

 Uses of Cohort study

 When exposure is rare and outcome is

common e.g. agriculture pesticide use and
cancer.
 To learn about multiple outcomes due to a
single exposure e.g. health effects of a
nuclear power plant accident.

Observational and Analytic Studies 7

 Cohort studies
Advantages Disadvantages
• Suited for assessing Time consuming because
effects of rare follow up may be for many
years.
exposures mainly
occupational. Expensive.
• Allows for must be conducted after a
examination of good hypothesis is
formulated.
multiple effects of
one exposure. have a potential for loss to
follow up.
• Minimizes potential
for selection bias.
Observational and Analytic Studies
 Analysis of Cohort Studies:
Person-Time, Rate
Quantifies occurrence of outcome in population by time
Calculation: number of new cases during follow-up period
Sum of time each study participant was
followed and at risk of disease

Example: 1,212 tunnel workers

160 deaths among tunnel workers
24,035 person-years at risk
Mortality rate = 160 / 24,035
= 6.7 deaths per 1,000 workers per year
.

Observational and Analytic Studies 30

 Case –control study designs.
 Groups of individuals are defined on the basis of
disease or no-disease to suspected exposure
factor.
 All subjects must already have developed
disease at start study.
Purpose,
 To study a rare disease.
 To study multiple exposures that may be related to a
single outcome.

Study Subjects.
 Participants selected based on outcome status:
 Case-subjects have outcome of interest.
 Control-subjects do not have outcome of interest

Observational and Analytic Studies 7

 Case-Control Study Design

Exposed
Cases
(Diseased)
Unexposed Identify
Assess cases Source
exposure and Population
history select
controls
Exposed
Controls
Unexposed (No Disease)

Observational and Analytic Studies 37

 Cohort vs. Case-Control Studies
Study Comparison Cohort Study Case-Control Study
Preferred Study Members are easily Identifying entire cohort
Design When… identifiable would be too costly or time
consuming
Members are easily
accessible Accessing entire cohort
would be too costly or time
Exposure is rare consuming

There may be multiple Illness is rare

diseases involved
There may be multiple
exposures involved
Study Group Exposed persons Persons with illness (cases)
Comparison Group Unexposed persons Persons without illness
(controls)

Observational and Analytic Studies 72

References:

Centers for Disease Control and Prevention (CDC) 2013.

Descriptive and Analytic Studies. Atlanta, Georgia.

Myers, P. J. (1998). General Introduction to Occupational

Health: Occupational Hygiene, Epidemiology & Biostatistics.
Cape Town: university of cape town.

Rothman KJ, S. G. (2008). Modern Epidemiology. chicago:

wolters kluwer Health / Lippincott Williams and Wilkin.

Wayne Martin S, A. H. (1987). Epidemiology: Principles and

Methods. Iowa: Iowa State University Press I Ames.