Professional Documents
Culture Documents
Cohort in epidemiology:
Cohort definition
- People living in a geographical area
Members of all worker ever employed in
one factory
- Cohort of workers from different plants
but engage the same industrial process
- Member of professional organization
Cohort Definition
Advantage of first option, restricting the
cohort to a place:
Characterization of exposure is more
consistent and precise
Pooling cohort members from multiple
facilities increases the study size
TIME
Disease
Exposed
Population
No disease
People
Without
disease
Disease
Not exposed
No disease
Prospective cohort
Prospective Cohort
Exposure
x
o
Retrospective Cohort
Exposure Disease
x
?
o
?
Disease
?
?
Scientific
Does
Logistic
Selection of exposed
population
Is the exposure common or rare in the
population?
Does it allow complete and accurate
Industrial-based (Occupational)
Living near suspected hazardous environment
Being present at given event (hiroshima
population, veteran of vietnams war)
information
Health insurance, profession, student
Selection of comparison
population
Groups being compared should be as
Selection of comparison
population
Internal comparison
Levels of exposure
Smoking among physician
Special comparison
Multiple comparison
Defining Exposure
Quality of exposure assessment
Yes/no or high/low
nonhomogenous
within group
Ordinal
dose-response
Continuous from relevant time
increases sensitivity
Measuring Exposure
Interviews, questionnaires, structured diaries
Measurements in external media
Exposure variable
Intensity = magnitude of the amount of a
Sources of Data
Exposure
Records
Questionnaire, Interview
Physical examination
Direct measurement
Outcome
Issues in Analysis
Bias
Losses to follow-up
Misclassification of exposure
Nondifferential: a similar proportion
of inaccuracy occurs in each study
group
Differential
Measure of association
Absolute measure
Relative measure
Risk ratio
Rate ratio
Incidence exposed
Incidence unexposed
Data analysis
Perhitungan RR untuk CI
Outcome (+)
Outcome (-)
E (exposed)
a+b
NE (unexposed)
c+d
Total
a+c
b+d
(a + b + c + d)
Total
Data analysis
Perhitungan RR untuk IR
Outcome (+)
Person-time
E (exposed)
N1
NE (unexposed)
N0
Total
a+c
SMR analysis
Study Cohort
Age
(1)
Obs
(2)
P-Y
40-49
50-59
60-69
70-79
6
27
98
48
1200
2340
3750
975
Total
179
Reference
population
(3)
Rate
per 1000
(4)
Exp = SMR =
(2) x (3) (1) : (4)
2.5
6.1
12.4
25
3
14.27
46.50
24.38
2
1.89
2.11
1.97
88.15
2.03
of
users?
Exposure
Population
(f/u 2 years)
Cases
Incidence
(%)
Relative
Risk
HIV +
215
3.7
11
HIV -
298
0.3
Population
at Risk
Cases Incidence
RR
High
N1
a1
I1
RR1
Medium
N2
a2
I2
RR2
Low
N3
a3
I3
RR3
None
N0
a0
I0
Ref
Presentation of data:
Various exposure levels
Strengths
Design of choice to study rare exposure
Can examine multiple outcomes of a
single exposure
Can elucidate temporal relation between
exposure and outcome
Minimize bias of exposure assessment
Direct measurement of incidence
Limitations
Inefficient to study rare disease
If prospective, costly and time
consuming
If retrospective, requires adequate
records
prone to losses to follow-up threat
validity of the result
A
B
C
D
E
F
G
H
Plant open
Cohort
enumeration
1960
1970
T1
End of follow-up
Dec 31, 1984