Analytical Study

&
Ecological Study

Assignment By - RA2352010010006, KARTHIKEYAN K

Team
 RA2352010010002 – KANTHAVASAN A
 RA2352010010006 – KARTHIKEYAN K
 RA2352010010007 – AKASH S
 RA2352010010017 – YUVANESH RAJJ M M
 RA2352010010021 – ASPHER RIXON D H
 RA2352010010022 – MOHAMMED FAZIL J
Introduction Study
To describe burden of disease or prevalence of risk factors, health behaviors, or
other characteristics of a population that influences risk of disease
• To determine causes or risk factors for illness
• To determine relative effectiveness of interventions

Epidemiological
Study

Descriptive Analytical

Analytical Study
• Second major type of epidemiological study
• Focus interest on small group of individual within the population
• Inference is not to individuals, but to the population from which they are
selected
• Objective is to test hypotheses and not to formulate one
• Measure the association between exposure and outcome

Classification of Analytical Study

Analytical

Experimental Observational

Case Control Cohort

Case Control Study
• Referred to as “Retrospective Study”
• Used to know the cause of diseases & to test casual hypotheses
• Both exposure and outcome (disease) have occurred before the start of the
study
• The study proceeds backwards from effect to cause
• It uses a control or comparison group to support or refute an inference
(Hypotheses)

Design -Case Control Study

Exposed
Cases
(With
Diseases)
Unexposed

Source
Population
Exposed
Control
(Without
Diseases)
Unexposed

Direction of Inquiry

Steps to follow When to follow

• Selection of cases & control • Outcome if interest is rare
• Matching • Multiple exposure associated
• Measurement of exposure with single outcome
• Analysis and interpretation • Funds or Time is limited.
Selection of Case Selection of Control
• Definition of Case • Definition of Case
 Diagnostics Criteria  Free from diseases
 Eligibility Criteria  Similar to case
• Source of Case • Source of Control
 Hospitals  Hospitals
 General Population  General Population
 Neighbourhood, Relatives

Matching
• The process by which we select controls in such a way that they are similar to
cases with regard to certain pertinent selected variables which are known to
influence the outcome of disease and which, if not adequately matched for
comparability, could distort or confound the results
• Example: age, sex, environment, etc.
• Methods of matching: By Groups and By pairs

Measurement Analysis
• Interview • Exposure rates among cases and
• Questionnaires controls to suspected factor
• Past history and records • Estimation of disease risk
• Examinations associated with exposure (Odds
• Unbiased ratio)
Framework - 2 x 2 Contingency Table
Suspected Case Control Exposure Rates :
(or) Risk (Disease (Disease
Factors present) absent) • Cases = a / (a + c)

Present a b a+b • Control = b / (b + d)

Absent c d c+d
Relative Risks or Risk Ratio:

n=a+b+ • {a / (a + b)} / {c / (c + d)}

a+c b+d
c+d
• Incidence among exposed /
Incidence among non exposed
Odds Ratio:
• (a / b) / (c / d) = ad / bc

Advantage
• Relatively easy to carry out, rapid and inexpensive
• Require comparatively few subjects, no risk to subjects
• Ethical problems minimal
• Particularly suitable to investigate rare diseases or diseases about which little
is known
• Risk factors can be identified. Rational prevention and control programs can
be established

Disadvantage
• Problems of bias relies on memory or past records
• Selection of an appropriate control group may be difficult.
• We cannot measure incidence and can only estimate the relative risk.
• Do not distinguish between causes and associated factors.
• Not suited to the evaluation of therapy or prophylaxis of disease.
• Another major concern is the representativeness of cases and controls.
 Cohort Study
• To obtain additional evidence to refute or support the existence, also
referred to as “Prospective Study” or “Longitudinal Study”
• Identified prior to the appearance of the disease under investigation
• The study groups, so defined, are observed over a period to determine the
frequency of disease among them
• The study proceeds forward from cause to effect

Design Cohort Study

Disease
Exposed
No Disease
People
Source without
Population disease
Disease
Unexposed
No Disease

Direction of Inquiry

Indications
• When there is good evidence of an association between exposure and
disease
• When exposure is rare, but the incidence of disease high among exposed
• When attrition of study population can be minimized
• When ample funds are available
Types of Cohort Study
• Prospective - one in which the outcome has not yet occurred at the time the
investigation begins
• Retrospective - one in which the outcomes have all occurred before the start
of the investigation
• Combination of both Prospective and Retrospective cohort study

Steps to follow When to follow

• Selection of study subjects • When the exposure is rare, and
• Obtaining data on exposure the outcome is common
• Selection of comparison groups • To learn about multiple
• Follow ups outcomes due to a single
• Analysis exposure

Selection of Subjects Obtaining Exposure

• General Population Data
• Special Groups • Cohort members
 Select Groups • Review of records
 Exposure Groups • Medical examination / special
test
• Environmental Surveys
• Degree of exposure
• Whether or not exposed
Comparison Follow ups
Selection • Periodic medical examination of each
• Internal selection member of the cohort
• External selection • Reviewing physician and hospital records
• Comparison with general • Routine surveillance of death records
population • Mailed questionnaires, telephone calls,
periodic home visits - preferably all three on
an annual basis.

Analysis
• Incidence rates of outcome Attributable Risk
among exposed and • {(Incident rate among exposed -
nonexposed Incident rate among non
• Estimation of risk exposed) / Incident rate among
 Relative Risk exposed} x 100
 Attributable Risk

Advantage
• Incidence can be calculated
• Several possible outcomes related to exposure can be studied simultaneously
• Cohort studies provide a direct estimate of relative risk
• Dose-response ratios can also be calculated
• Certain forms of bias can be minimized like mis-classification of individuals
into exposed and unexposed groups.
Disadvantage
• Involve many people - unsuitable for rare diseases
• It takes a long time to complete the study and obtain results
• Certain administrative problems such as loss of experienced staff, loss of
funding and extensive record keeping are inevitable
• It is not unusual to lose a substantial proportion of the original cohort
• Selection of comparison groups is a limiting factor
• Expensive in terms of time, cost, personally, space and follow up

Case – Control Study Cohort Study

Proceeds from effect to cause Proceeds from cause to effect
Starts with the disease Starts with people exposed to risk factor
Involves fewer number of subjects Involves larger number of subjects
Yields relatively quick results Long follow up period
Suitable for the study of rare diseases Inappropriate for rare diseases
Generally, yields only estimate of RR (Odds Yield incident rate RR as well as AR
ratio)
Relatively inexpensive Expensive in comparison
Cannot yield information about disease other Can yield information about more than 1
than selected for study diseases
Usually used for testing the hypotheses and Used for testing precisely formulated
exploration studies as well hypotheses
Ecological Study - Meaning
• In epidemiology, ecological studies are used to understand the relationship
between outcome and exposure at a population level
• Where 'population' represents a group of individuals with a shared
characteristic such as geography, ethnicity, socio-economic status of
employment

Methods of Ecological Study

Cross-Sectional Time-Trend Descriptive

Ecological Ecological Ecological
Study Study Study

Cross-Sectional Ecological Study

• Cross-sectional ecologic studies compare aggregate exposures and outcomes
over the same time period.
• An example of this study design is an investigation comparing bladder cancer
mortality rates in cities with surface drinking water sources that contain
chlorine by-products compared to rates in cities with ground drinking water
sources that contain little or no chlorine by-products
Graphical Representation

Time Trend
• Time-trend ecologic studies compare variations in aggregate exposures and
outcomes over time within the same community
• A study investigating whether hospital admissions for cardiac disease in Los
Angeles increase on days when carbon monoxide levels are higher would be
an example of this type of study

Graphical Representation
Descriptive
• Solely descriptive ecologic studies investigate disease or risk factor
differences between communities at the same time, or within the same
community over time. This type of study design would be used to investigate
the following questions:
• What are the differences in lung cancer mortality among cities in North
Carolina?
• What is the secular trend of lung cancer mortality between 1960 and 2010
for the entire state of North Carolina?

Limitations
• Usually, Hypothesis Generating
• Lack of adequate data and missing data
• Within-Group Misclassification
• Confounding
• Collinearity
• Temporal Ambiguity
• Ecological Fallacy

Features of Ecological Study

• Low cost and convenience
• Some measurements cannot be made on individuals
• Ecologic effects are the main interest (at the population level)
• Often helpful for generating new hypothesis for further research

Thank you