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CaseControl
study
Crosssectional
study
Cross-sectional
studies
Case-Control
studies
Strength of evidence
Strongest
Weakest
Meta-analysis of RCT
Randomized Controlled Trials
Community Intervention Design
Quasi Experimental design
Meta-analysis of observational st.
Cohort Design
Cross-sectional design
Case-Control design
Case series
Case report
Case-Control Studies
Synonyms
Retrospective study
Case reference study
Case comparison study
Case history study
Definition
An epidemiological approach in
which the researchers start by
picking up cases (with disease) and
controls (without the disease) and
finds out the presence of particular
exposure which he/she thinks is a
risk factor and compares the two
groups as regards the presence of
exposure
Advantages
Inexpensive, requires only a few subjects gives
quick results
Well suited for diseases which have a long latent
period (e.g. cancers, AIDS, MI, CVA etc.)
Well suited for an outcome which is rare
Well suited for conditions in which medical care is
usually sought
Helps in examining multiple etiologic factors - once
we have the cases of the disease, we can take
history of all the factors that we feel may be risk
factors
Reasonably good for diseases that have a
relatively rapid onset and are usually hospitalized
(e.g. most of the acute infections; injuries etc.)
Disadvantages
Not a good method for studying rare exposures
Does not give any idea of incidence or
prevalence; it only gives us a measure of Odds
Ratio (OR)
Particularly prone to various forms of selection
and information biases, particularly survivorship
Bias, Recall Bias and observers bias.
Temporal Relationship is usually only a matter
of conjecture but not a proof
1-/2
+z
1-
)2 * p
*q
n=
----------------------------(p1 - p0)2
Source of cases:
Methods of Sampling:
Matching:
list out all confounding factors, as well as universal
confounding factor age, sex etc.
7: Do a Pilot Study
Pre-testing of part of a sample
In order to improve the actual
studys quality and efficiency
Can reveal deficiencies in the design
of a proposed study
Bias can be avoided
Reliability
Check for variations due to
Observer
Subjects
Instruments and techniques
9: Analysis of Data
Calculate
Odds Ratio with 95% Confidence Interval
Testing of Hypothesis
Use Chi-square test or t test depending
upon variable
Control confounding variable through
stratified analysis with Mantel-Hanszel
technique or Multiple logistic Regression
Pair-matched study use McNemars
Chi-square, OR, 95% CI of OR.
Odds ratio
A ratio that measures the odds of
exposure for cases compared to
controls
Odds of exposure = number
exposed number unexposed
OR Numerator: Odds of exposure
for cases
OR Denominator: Odds of
exposure for controls
AD
BC
112 x 224
176 x 88
= 1.62
Estimate of OR
OR<1
OR=1
Odds of
Odds of
Odds
exposure for exposure
compariso
cases are
are equal
n between less than the
among
cases and
odds of
cases and
controls
exposure for
controls
controls
Exposure
Exposure
reduces
Particular
as a risk
disease
exposure is
factor for
risk
not a risk
the
factor
(Protective
disease?
factor)
OR>1
Odds of
exposure
for cases are
greater than
the odds of
exposure for
controls
Exposure
increases
disease risk
(Risk factor)
or
or
Those with CHD are 62% more likely to be
smokers than those without CHD