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COHORT STUDIES

In 1948, a long-term observational study began in Framingham Massachusetts. Fifty-one


hundred subjects without cardiovascular disease (CVD) were selectrd and examined, and
information about potential risk factors for tihis were then re-examined if possible every 2 years
over the next 50 years. This classic study became known as the Framingham heart study and has
been the source of much of our knowledge about risk factors for cardiovascular disease. The
Framingham heart study is an example of a prospective cohort study.
A cohort design stars with subjects who do not have a health outcome of interest and are
followed forward to determine health outcome status. A key feature of a cohort study is that
subjects are grouped on the basis of their exposure characteristics prior or observing the health
outcome, that is, the directionality of the study is always forward.
A cohort study may be retrospective or prospective. The Framingham heart study is an example
of a prospective study since the study began before the health outcome occurred.
Summary
-

The Framingham heart study is a classic example of a cohort syudy


The cohort design is always a follow-up study with forward directionality
A cohotrt study can be prospective or retrospective
The Framingham study is a prospective cohort study because the study began before the
health outcome occurred

ADVANTAGES OF a COHORT STUDY


The primary adavantage of a cohort study is its forward directionality. The investigator can be
reasonably sure that the hypothesized cause preceded the occurrence of desease. In a cohort
study, disease status cannot influence the way subjects are selected, so a cohort study is free of
certain selection biases that seriously limit other types of studies.
A prospective cohort design is less prone than other observational study designs to obtaining
incorrect information on important variables. Cohort studies can be used to study several
diseases, since several health outcomes can be determined from follow-up.
Cohort studies are also useful for examining rare exposures. Since the investigator selects
subjects on the basis of exposure, he can ensure a sufficient number of exposed subjects. A
retrospective cohort study can be relatively low-cost and quick. Occupational studies that are
based on employment records and death certificates or insurance an workers comp records are
an example.

DISADVANTAGES OF a COHORT STUDY


A prospective cohort study is often quite costly and time-consuming. A potential problem in any
cohort study is the loss of subjects because of migration, lack of participation, withdrawal, and
death. Such attrition of the cohort over the fllow-up period can lead to biased results.
A cohort design is statistically and practically inefficient for studying a rare disease with long
latency because of the long follow-up time and the number of subjects required to identify a
sufficient number of cases. However, a retrospective cohort study may find enough cases since
the study events of interest have already occurred.
Another problem in cohort studies is that the exposed may be followed more closely than the
unexposed; if this happens, the outcome is ore likely to be diagnosed in the exposed. This might
create an appearance of exposure-disease relationship where none exists.
Summary: cohort study +s (advantages) and-s (disadvantages)
-

(+) prospevtive cohort study: least prone to bias compared with other observational study
designs.
(+) can address several disease in the same study.
(+) retrospective cohort study: can be relatively low-cost and quick; frequently used in
occupational studies.
(-) loss to follow-up is a potential source of bias
(-) prospevtive cohort study: quite costly and time-consuming; may not find enough cases
if disease is rare
(-) if exposed are followed more closely than unexposed, the outcome is more likely to be
diagnosed in exposed

Example: retrospective cohort study of spontaneous abortions


The relationship between adverse pregnancy outcomes and the use of video display terminals
(VDTs) became a public health concern in the 1980s when adverse pregnancy outcomes were
reported among several clusters of women who used VDTs. A more comprehensive study of the
effect of VDTs was reported in the new England journal of medicine in 1991. This study,
conducted by the national institute for occupational safety and health (NIOSH) used a
retrospective cohort design to example the hypothesis that electromagnetic energy produced by
VDTs might cause spontaneous abortions.
In the NIOSH study, a cohort of female telephone operators who were employed between 1983
and 1986 was selected for employers personnel records at two telephone companies in eight
southeastern states in the US. In this cohort, there were 882 women who had pregnancies that
met the inclusion criteria for the study. Of these women, the pregnancy outcomes of 366
directory assistance operators who used VDTs at work were compared with 516 general
telephone operators who did not use VDTs.

The results of the study showed no excess risk of spontaneous abortion among women who used
VDTs during their first trimester of pregnancy. No dose-response relation was found from the
analysis of the womens hours of VDT use per week either. Also, no excess risk was associated
with VDT use when other relevant characteristics of the study subjects were taken into account.
The investigators therefore concluded that the use of VDTs and exposure to electromagnetic
fields they produce were not associated with an increased risk of spontaneous abortion.
Summary
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A 1991 study used a retrospective cohort design to examine the hypothesis that
electromagnetic energy produced by VDTs might cause spontaneous abortions
The pregnancy outcomes of 366 operators who used VDTs at work were compered with
516 operators who did not use VDTs
The results of the study showed no excess risk of spontaneous abortion among women
used VDTs

Example: prospective cohort study of alzheimers disease


inflammatory activity in the brain is thought to contribute to the development of alzheimers
disease. This hypothesis suggests that long-term use of nonsteroidal anti-inflammatory drugs
(NSAIDs), may reduce the risk of this disease.
This hypothesis was investigated within the rotterdam study, a cohort study of the elderly that
started in the Netherlands in 1990. At that time, 7,000 participants didi not have alzheimers
disease. During eight years of follow-up, 293 of the participants developed the disease.
To avoid information bias from measuring NSAIDs, the investigators used computerized
pharmacy records instead of interview data to determine the total number of mots during which
participants had used NSAIDs after thestudy onset. Controlling for age, gender, and smoking
status, the investigators found that the risk of alzheimers for participants who had used NSAIDs
for more than 24 monts was significantly less than the risk of alzheimers disease for
paryicipants who used NSAIDs for less than or equal to 24 monts. The investigators concluded
that ling-term use of NSAIDs has a beneficial effect on the risk of alzheimers disease.
Summary
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The Rotterdam study examined the hypothesis that long-term use of nonsteriodal antiinflammatory drugs (NSAIDs) may reduce the risk of alzheimers disease.
The study used a prospective cohort design that followed 7,000 paricipantas without
alzheimers disease in 1990 over eight years
The risk of alzheimers disease for subjects using NSAIDs for more than 24 monts was
significantly smaller than for subjects using NSAIDs less than or equal to 24 months

STUDI KOHORT
Pada tahun 1948, pengamatan studi jangka panjang mulai di Framingham Massachusetts. Lima seratus mata pelajaran tanpa penyakit kardiovaskuler (CVD) selectrd dan memeriksa, dan
informasi tentang faktor risiko potensial untuk tihis kemudian kembali diperiksa jika mungkin
setiap 2 tahun selama 50 tahun. Studi klasik ini dikenal sebagai Framingham jantung studi dan
telah menjadi sumber banyak pengetahuan kita tentang faktor-faktor risiko untuk penyakit
kardiovaskular. Framingham jantung studi adalah contoh prospektif kohort studi.
Desain kohort bintang dengan subyek yang tidak memiliki hasil kesehatan yang menarik dan
diikuti maju untuk menentukan status hasil kesehatan. Fitur utama dari Studi kohort adalah
bahwa subyek dikelompokkan berdasarkan karakteristik eksposur mereka sebelumnya atau
mengamati hasil kesehatan, yaitu directionality studi selalu maju.
Studi kohort mungkin retrospektif atau calon. Framingham jantung studi adalah contoh dari
sebuah penelitian prospektif sejak studi dimulai sebelum hasil kesehatan terjadi.
Ringkasan
-Studi jantung Framingham adalah contoh klasik dari Angkatan syudy
-Desain kohort selalu studi lanjutan dengan maju directionality
-Studi cohotrt dapat calon atau retrospektif
-Studi Framingham adalah penelitian prospektif kohort karena studi dimulai sebelum terjadi hasil
kesehatan
KEUNTUNGAN dari studi KOHORT
Adavantage utama dari Studi kohort adalah directionality yang maju. Penyidik dapat cukup
yakin bahwa penyebab hypothesized mendahului terjadinya penyakit. Dalam sebuah studi
kohort, yang status penyakitnya tidak dapat mempengaruhi cara subyek yang dipilih, sehingga
Studi kohort tidak bias pilihan tertentu yang serius membatasi jenis studi.
Sebuah desain prospektif kohort kurang rentan daripada desain pengamatan studi lainnya untuk
memperoleh informasi yang salah pada variabel penting. Studi kohort dapat digunakan untuk
belajar beberapa penyakit, karena beberapa hasil kesehatan boleh ditentukan dari tindak lanjut.
Studi kohort juga berguna untuk memeriksa langka eksposur. Karena para penyelidik memilih
mata pelajaran berdasarkan paparan, ia dapat memastikan jumlah yang memadai terkena mata
pelajaran. Studi kohort retrospektif dapat relatif murah dan cepat. Kerja studi yang didasarkan

pada kerja catatan dan sertifikat kematian atau asuransi pekerja comp catatan adalah sebuah
contoh.

KERUGIAN dari studi KOHORT


Penelitian prospektif kohort ini sering cukup mahal dan memakan waktu. Masalah potensial
dalam Studi kohort apapun adalah hilangnya mata pelajaran karena migrasi, kurangnya
partisipasi, penarikan dan kematian. Seperti musush kelompok fllow-up periode dapat
menyebabkan hasil yang bias.
Sebuah desain kohort Statistik dan praktis tidak efisien untuk mempelajari penyakit langka
dengan latency panjang karena waktu lama ikutan dan jumlah mata pelajaran yang diperlukan
untuk mengidentifikasi jumlah kasus yang memadai. Namun, Studi kohort retrospektif mungkin
menemukan cukup banyak kasus sejak peristiwa studi menarik telah terjadi.
Masalah lain dalam Studi kohort adalah bahwa yang terkena mungkin diikuti lebih dekat
daripada tidak terpajan; Jika ini terjadi, hasil yang mungkin untuk dapat didiagnosis bijih di
terkena. Ini mungkin membuat penampilan hubungan eksposur-penyakit yang mana tidak ada.
Ringkasan: kohort studi +'s (keuntungan) dan -'s (kekurangan)
-(+) Studi kohort prospevtive: sedikit rentan terhadap bias dibandingkan dengan desain
pengamatan studi lainnya.
-(+) dapat mengatasi beberapa penyakit dalam studi yang sama.
-(+) Studi kohort retrospektif: dapat relatif murah dan cepat; sering digunakan dalam pekerjaan
studi.
-kerugian (-) untuk menindaklanjuti merupakan sumber berpotensi bias
-Studi kohort (-) prospevtive: cukup mahal dan memakan waktu; mungkin tidak menemukan
cukup banyak kasus jika penyakit langka
-(-) jika terkena diikuti lebih dekat daripada unexposed, hasil terkena lebih mungkin untuk dapat
didiagnosis di
Contoh: Studi kohort retrospektif aborsi spontan
Hubungan antara hasil kehamilan merugikan dan penggunaan video display Terminal (VDT's)
menjadi masalah kesehatan masyarakat di tahun 1980-an ketika hasil kehamilan merugikan
dilaporkan antara beberapa kelompok perempuan yang digunakan VDT's. Studi yang lebih
komprehensif efek VDT's dilaporkan dalam new England journal of medicine pada tahun 1991.
Studi yang dilakukan oleh Institut Nasional untuk keselamatan dan kesehatan (NIOSH)
digunakan desain retrospektif kohort contoh hipotesis bahwa energi elektromagnetik yang
dihasilkan oleh VDT's mungkin menyebabkan aborsi spontan.
Dalam studi NIOSH, sebuah kohort operator telepon perempuan dipekerjakan antara 1983 dan
1986 dipilih untuk majikan personil records di dua perusahaan telepon di delapan Serikat
Tenggara di Amerika Serikat. Dalam kelompok ini, terdapat 882 wanita yang memiliki
kehamilan yang memenuhi kriteria inklusi untuk studi. Perempuan ini, hasil kehamilan 366
direktori bantuan operator