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Cohort Study.. Design, Steps, Analysis: Dr. Jatin Chhaya

This document describes the key aspects of designing and conducting a cohort study. It discusses defining the cohort and comparison groups, collecting exposure data, following participants over time, and analyzing results by calculating incidence rates and measures of risk like relative risk and attributable risk. The goal of a cohort study is to establish temporal relationships and quantify the strength of associations between exposures and outcomes.

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Shivani Shah
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249 views33 pages

Cohort Study.. Design, Steps, Analysis: Dr. Jatin Chhaya

This document describes the key aspects of designing and conducting a cohort study. It discusses defining the cohort and comparison groups, collecting exposure data, following participants over time, and analyzing results by calculating incidence rates and measures of risk like relative risk and attributable risk. The goal of a cohort study is to establish temporal relationships and quantify the strength of associations between exposures and outcomes.

Uploaded by

Shivani Shah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Cohort Study..

Design, Steps, Analysis

Dr. Jatin Chhaya


Research studies

09/18/2021 Dr. Nilesh G. Patel 2


Design of Cohort study
Exposure No Disease
(People with Exposure)

Population Disease

Disease
Comparison gp
(People without Exposure)
No Diasese

Direction of inquiry

Time- Forward
Concept of cohort
• The cohort is defined as a group of people
who share a common characteristic or
experience within a defined time period.
- Marriage cohort,
- Birth cohort,
- Exposure cohort
- Occupation cohort…..
Comparison Group
• It may be general population from which the
cohort is drawn,
or
• It may be another cohort of persons thought
to have had little or no exposure to the
substance in question but otherwise similar
Indication for cohort study

• When there is good evidence of an association


between exposure and disease after
descriptive & case-control study.
• When exposure is rare, but the incidence of
disease is high among exposed
• When ample funds are available.
Pre-requisite

• Cohort must be free from the disease under


study
• Both group should equally susceptible to the
disease under study.
• Both group should be comparable
• Diagnostic & eligibility criteria of the disease
must be defined before hand.
Basic steps
1. Selection of study objects
2. Obtaining data on exposure.
3. Selection of comparison group.
4. Follow up.
5. Analysis
1. Selection of study objects

• General population: When the exposure or cause of


death is fairly frequent in the population, cohorts may be
assembled from the general population, residing in well-
defined geographical, political and administrative areas
• Special groups:
– Selected groups : These may be professional groups
(e.g., doctors, nurses, lawyers, teachers, civil servants)
– Exposure groups : If the exposure is rare, A readily
accessible source of these groups is workers in
industries and those employed in high-risk situations
(e.g., radiologists exposed to X-rays).
2. Obtaining data on exposure
Information about exposure may be obtained directly
from
• Cohort members – through interview of personal
questionnaires
• Review of records – certain surgery, dose of radiation
etc
• Medical examination / test – blood pressure or
cholesterol
• Environmental surveys – exposure level of suspected
factor in environment
Information on Exposure
Classification
• according to whether or not they have been
exposed to the suspected factor, and
• according to the level or degree of exposure,
at least in broad classes, in the case of special
exposure groups
3. Selection of comparison groups
• Internal comparison-
2 cigarettes per day Vs 2 packs/day
• External comparison- when information on degree of
exposure not available
Cohort of radiologist Vs Ophthalmologist
• Comparison with general population rate- If none is available,
the mortality experience of the exposed group is compared
with the mortality experience of the general population in the
same geographic area as the exposed people, e.g.,
comparison of frequency of lung cancer among uranium mine
workers with lung cancer mortality in the general population
where the miners resided
4. Follow up
Procedure required are:
• Periodic medical examination of each member
of cohort
• Reviewing physician and hospital records
• Routine surveillance of death records
• Mailed questionnaire or telephone calls
periodic home visits
5. Analysis
• Incidence rate of outcome among
exposed and non exposed
• Estimation of risk
Incidence rate
Estimation of risk
• Relative Risk
• Attributable risk
• Population attributable risk
Relative Risk/Risk Ratio

Incidence amongst exposed


Relative Risk = Incidence amongst non-exposed
Framework
Lung CA No CA lung Total
Smoker 500 500 1000
Non smoker 100 900 1000
Total 600 1400 2000

Incidence amongst exposed = 500/1000 = 50%


Incidence amongst non exposed =100/1000 = 10%
Incidence amongst exposed
Relative Risk = Incidence amongst non-exposed

= 50/10
=5
Smokers have 5 times higher risk of CA lung as
compared to non-smokers
Exposer have _____times have higher risk of
having Disease compared to Non-exposed
Relative Risk (RR)
• Direct measure of STRENGTH OF ASSOCIATION
between the suspected cause & effect.
• RR of one indicates no association
• >1 indicates positive association between exposure &
effect.
• Larger the RR, greater the strength of association.
Attributable risk/ Risk Difference
• TO WHAT EXTENT THE DISEASE UNDER STUDY, ATTRIBUTED
TO THE EXPOSURE

• Difference in incidence rates of disease between an exposed


group and non exposed group.
• A.R.=
Incidence of Disease in Exposed (MINUS)- Incidence of Disease
in NOT Exposed x 100…………………………….
Incidence of Disease in Exposed

• 80% of lung cancer cases among smokers are due to smoking.


Population Attributable risk
• Difference in incidence rates of disease between an
Population and non exposed group.
• The concept of population attributable risk is useful
in that it provides an estimate of the amount by which
the disease could be reduced in that population if the
suspected factor was eliminated or modified.
• A.R.=
Incidence of Disease in Population (MINUS)-
Incidence of Disease in NOT Exposed x 100
Incidence of Disease in Population
PROSPECTIVE STUDY: PROS & CONS

PROS CONS
• Less variability to • Consistent disease definitions
bias & symptoms.
•
• No recall
•
Longer time
Common disease only
necessary
• Expensive
• (no recall BIAS) • Ethical concern
• Incidence • A high drop-out rate
determined • Volunteers needed
• Relative risk • A large no. of subjects needed
more accurate
• Kannel WB, McGee DL. Diabetes and
cardiovascular disease: the Framingham study.
Jama. 1979 May 11;241(19):2035-8.
MCQs..
1) A study began in 1970 with a group of 5000
adults in Delhi who were asked about their
alcohol consumption. The occurrence of cancer
was studied in this group between 1990-1995.
This is an example of:
• (a) Cross-sectional study
• (b) Retrospective cohort study
• (c) Concurrent cohort study
• (d) Case-control study
2) TATA memorial hospital conducted a cohort
study on 7000 subjects who were smokers over a
ten-year period & found 70 subjects developed
lung cancer. Concurrent evaluation of general
population in the catchment area of hospital, out
of 7000 non-smoker subjects only 7 developed
lung cancer. The RR for developing lung cancer is:
• (a) 1 Lung cancer No Lung Total
• (b) 10 Smoker 70
Cancer
6930 7000
• (c) 100 Non-smoker 7 6993 7000

• (d) 0.1
3) Several studies have shown that 85% of
cases of lung cancer are due to cigarette
smoking. It is a measure of:
• (a) Incidence rate
• (b) Relative risk
• (c) Attributable risk
• (d) Population attributable risk
4) The incidence of carcinoma cervix in women
with multiple sexual partners is 5 times the
incidence seen in those with a single partner.
Based on this, what is the attributable risk?
• (a) 20%
• (b) 40%
• (c) 50%
• (d) 80%
5) Attribute risk gives a better idea of:
• (a) Strength of association between cause and
effect
• (b) Impact of successful preventive health
programme
• (c) Assessing aetiological role or factor in
disease
• (d) Potential public health importance of
disease
• Answers
1. C
2. B
3. C
4. D
5. B

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