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Cross-sectional Study designs

Dr Hamid Hussain

LEARNING OBJECTIVES
Learner should be able to know at the end of this lecture

Classify study designs? Descriptive and Analytical epidemiology? What is a cross-sectional study? When to conduct cross-sectional study? How to test the hypothesis by means of a crosssectional study?

PERFORMANCE OBJECTIVES
LEARNER SHOULD BE ABLE TO
Conduct the cross-sectional study for

any new hypothesis


Apply this cross sectional analytical method when situation demands

Study design: Definition

A study design is a specific plan or protocol for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one.

Study designs
Study types

Descriptive (formulation hypothesis)

Analytical (testing hypothesis)

Individual based

Population based

Observational

Interventional

Case studies

co-relational

Case-control

RCTs (III)

Quazi experimental
Case series cohort

Crosssectional

Descriptive Studies
Descriptive studies describe the pattern of disease in relation to Person, Place and Time. Descriptive studies use information from diverse sources like clinical records of hospital or private practices as well as national figures. While features inherent in their design preclude the ability to test hypotheses, these studies are very useful to describe the pattern of disease occurrence as well as formulate research questions.

Descriptive Studies
Descriptive studies are the most frequently encountered study design
The identification of descriptive characteristics frequently constitutes an important first step in the search for determinants or risk factors that can be altered or eliminated to reduce or prevent the disease.

Descriptive study designs


Case Report
Case Series
One case of unusual finding Multiple cases of finding Population-based cases with denominator

Descriptive Epidemiology Study

Descriptive Studies
Increasing Knowledge of Disease/Exposure

Develop hypothesis

Cross sectional studies Investigate its relationship to outcomes Define its meaning with exposures

Case-control Studies
Cohort Studies

Clinical trials

Test link experimentally

Study Designs Analytic Epidemiology


Experimental Studies
Randomized controlled clinical trials Quazi experimental studies

Observational Studies
Group data Ecologic Individual data Cross-sectional Cohort Case-control Case-crossover

Cross-sectional study
A cross-section is the shape that results from

cutting a slice from an object.


The sampling frame usually conforms to the

snapshot analogy.
A cross-sectional study studies, disease and risk factor patterns in a representative part of the population, in a narrowly defined time period.

Cross Sectional

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Cross sectional study


Primarily, this study provides information
on prevalence of disease and risk factors.

The measurements are made over a


relatively short period of time such as a year

or two.
Excellent for measuring the population

burden of disease.

Cross-sectional study
It also can seek associations, generate and
test hypotheses and, by repetition, be used to measure change. Ideal cross-sectional study is of a geographically defined, representative sample of the population studied within a slice of time and space.

Cross sectional study


People representing virtually all stages

of health and disease.


Indirect insights on the natural history.

Cross-sectional studies
An observational design that surveys exposures and disease status at a single point in time (a cross-section of the population)

time Study only exists at this point in time

Cross-sectional Design
factor present No Disease

factor absent
Study population factor present

Disease
factor absent

time Study only exists at this point in time

Design
Define population

Gather Data on Exposure and Disease

Exposed and have the disease (a)

Exposed but have no disease (b)

Not Exposed and have the disease (c)

Neither Exposed nor have the disease (d)

Analysis: Cross Sectional design


Disease No disease
Exposed Not exposed Total

a
c
a+c

b
d
b+d a+b+c+d

Odds Ratio
Disease DVT 40 10 No DVT 20 30

Exposure

Used OC No OC

Number developing DVT among OC users/ Number developing DVT among Non users NOT developing DVT among OC users/ NOT developing DVT among Non users

Odds Ratio = 40/10 20/30 = 4/0.67 = 5.97 or 6 The odds of DVT in OC users was 6 times the odds of DVT in NON OC users

Cross-sectional Studies are Often used


to study conditions that are relatively frequent with long duration of expression (nonfatal, chronic conditions)

It measures prevalence
It can not measure incidence of disease

Not suitable for studying rare or highly fatal diseases or a disease with short duration

Cross-sectional Studies
Advantages;
Easy to carry out. Economical to conduct Rapid method for collecting health information as part of Rapid Epidemiological Assessment (R.E.A) methodology. Can be conducted to assess the health care needs of the population.

Advantages;(contd)
Helpful in measuring access and utilization of health services. Helpful in developing an etiological hypothesis. Provides information between disease and various variables. Provides information regarding distribution of a disease. Determines burden of the diseases in a population. So helpful for planning purposes.

Cross-sectional studies
Disadvantages Weakest observational design, (it measures prevalence, not incidence of disease). Gives no measure
of new cases occurrence

The temporal sequence of exposure and effect may be difficult or impossible to determine So gives no
information whether which comes first e.i. Cause or Disease.

Rare events are a problem. Prevalent cases are survivors. Gives no direct idea about
natural history of the disease or etiology. Neymans bias. Miss earlier cases that have died or recovered