Epidemiologic study designs

THE AGA KHAN UNIVERSITY PAKISTAN

Dr. Sunita Dodani Assistant Professor Family Medicine, CHS

Learning Objectives
To understand the concepts of different study designs To learn about the advantages and disadvantages of several study designs

Performance Objectives
After this lecture the student will be able To recognize concepts of different study designs To appropriately use a study design in research projects

Epidemiologic study designs

The basis for the lecture is the distinction between descriptive epidemiology and analytic epidemiology Descriptive epidemiology: seeks to measure the frequency in which diseases occur or collect descriptive data on possible causal factors. Analytic epidemiology: attempts to specify in more detail the causes of a particular disease

Epidemiologic study designs

Types of Epidemiologic Observational Studies based on: type of sampling from population based on Exposure &/or Disease or neither temporal sequence of observation - one time point, forward, backwards

Epidemiologic study designs

Types of Studies A. Experimental - study factor is manipulated by the investigator Types
1. Pure versus Quasi-experimental 2. Laboratory versus real world

B. Observational - no manipulation of study factor by the investigator

1. Descriptive versus Analytic 2. Retrospective versus Prospective

Epidemiologic study designs

Factors Important in Study Design A. Specific, testable hypotheses - NOT a fishing expedition B. Biases 1. Internal validity 2. External validity

Epidemiologic study designs Study designs

Case series Case Series report new diseases or health related problems. They may provide some descriptive data on exposures to potential causal factors

Epidemiologic study designs

Cross-sectional studies Cross-Sectional Studies measure existing disease and current exposure levels. They provide some indication of the relationship between the disease and exposure or non-exposure

Epidemiologic study designs

Cross Sectional Studies (contd) sample without knowledge of Exposure or Disease sample at one point in time Mostly prevalence studies/surveys

Epidemiologic study designs

Cross Sectional Studies Advantages
Good design for hypothesis generation Can estimate overall and specific disease prevalence and sometimes rates Can estimate exposure proportions in the population Can study multiple exposures or multiple outcomes or diseases
(contd)

Epidemiologic study designs

Cross Sectional Studies Advantages

(contd)

Relatively easy, quick and inexpensive No issue of subjecting any animals or producers to particular treatments Best suited to studying permanent factors (breed, sex, blood-type) Often good first step for new study issue

Epidemiologic study designs Cross Sectional Studies

Disadvantages
Impractical for rare diseases Not a useful type of study for establishing causal relationships Confounding is difficult to control No control over sample size for each exposure by disease subclass

Epidemiologic study designs Cross Sectional Studies

Disadvantages
Problems with temporal sequence of data hard to decide when disease was actually acquired disease may cure the exposure miss diseases still in latent period recall of previous exposure may be faulty

Epidemiologic study designs

Case-control studies
Case-Control Studies identify existing disease/s and look back in previous years to identify previous exposures to causal factors. Cases are those who have a disease. Controls are those without a disease. Analyses examine if exposure levels are different between the groups.

Epidemiologic study designs

Case-control studies Advantages
Best design for rare diseases Can be accomplished quickly since events of interest have already occurred Can study several potential exposures at the same time Lends itself well to hospital-based studies and outbreaks

Epidemiologic study designs

Case-control studies
Disadvantages Problems with temporal sequence of data Hard to decide when disease was actually acquired Disease may cure the exposure Miss diseases still in latent period Cant calculate incidence, population relative risk or attributable risk HIGH potential for bias

Epidemiologic study designs

Cohort Studies
In a cohort study, subjects with an exposure to a causal factor are identified and the incidence of a disease over time is compared with that of controls (persons who do not have the exposure). In a longitudinal study, subjects are followed over time with continuous or repeated monitoring of risk factors or health outcomes, or both.

Epidemiologic study designs

Cohort Studies
Advantages

Can get best assessment of exposure and can deal with changes in exposure May be only design if exposure needs to be measured directly Allows study of rare exposures Only way to get prospective information for rapidly fatal diseases Good for establishing temporal sequence and natural history of disease Can examine multiple outcomes linked to exposure often find other effects than

Epidemiologic study designs

Cohort Studies
Advantages
Can estimate overall and specific disease rates, usually incidence Researcher selects, measures & records data Lower potential for bias than a case-control study - no recall and selection bias Results are considered more conclusive than results from case-control studies The longer a cohort study continues, the stronger it can become

Epidemiologic study designs

Cohort studies
Disadvantages Impractical for rare diseases - even if risk is high, no cases may occur or results may not be statistically significant Larger sample size than case-control Data collection is usually very expensive Long time commitment for follow-up

Epidemiologic study designs

Other designs: Time series - test if incidence of disease changes in
a population over time Hybrid - often what is seen in practice Can be efficient and match necessity Can lead to bias and disaster

Meta-analysis
Combining results from a range of published studies Established methodology, not just literature review

Epidemiologic study designs

What type of study to chose depends on: what is the research question/ objective
Time available for study Resources available for the study Common/rare disease or production problem Type of outcome of interest Quality of data from various sources Often there are multiple approaches which will all work Choosing an established design gives you a huge head start in design, analysis and eliminating biases