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Done By : Ahed Da’na

Edited By : Shaikhah Al Matrouk

Lect. Date : 12/11/2018

Doctor : Labib Sharif

Subject : Cohort Study

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 Cohort study
In general the epidemiological studies are classified into :

1)- Descriptive epidemiology : describe the occurrence of the disease according

to person , time and place ( which we discussed previously ).

2)- Analytic epidemiology :study that identify the risk factor which is associated
with a disease .

*And the analytic epidemiology is subdivided into :

1)- observational study : the researcher doesn’t interfere with what’s going on
, he just observe .

2)- experimental study : the researcher interfere in the field clinical bracket .

 The observational studies includes 3 important epidemiological

studies:
1. Cross sectional studies
2. Cohort studies( also called follow up study )
3. Case control study

In this lecture we are going to discuss cohort study :

HOW to do cohort study ?

 First of all, you classify the target of study (from population) into 2
groups
1- Exposed group to the factor
2- Not exposed to the factor
 But without controlling or asking these groups to be exposed or not to
this factor
Ex: we want to make study on school students chosen randomly,

We divide the population into two groups: students who brush their teeth daily and students who do
not brush their teeth daily, without interfering with their attitude on brushing (I don’t give them
advice on brushing, I just observe their attitude without telling them to brush or not brush their
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teeth)

You just observe their response and follow up these 2 groups to record the incidence of the disease

In this case, the disease is dental caries.

You then follow up them for a certain time depending on your study (maybe months or years), also it
depends if the disease is acute or chronic. 1
 Cohort study
There is a famous study in Britain in which they were targeting the smokers,

 They follow up the smokers and nonsmokers for many years (10 years)
 They want to see the incidence of developing lung cancer and heart
disease in each group(in both smokers and nonsmokers)
So they classify the target population into exposed and unexposed
And they follow up the disease occurrence and its rate in each group
>> notice that both of them didn’t have the disease when they start the
study  so it’s a must in this study to select people who are free from
the disease when you start your study on them.

Research question in cohort studies:

When I do his study I will be able to answer these questions :

4 IS THERE AN ASSOCIATION BETWEEN THE RISK FACTOR AND THE DISEASE?

WHAT IS THE INCIDENCE OF THE DISEASE IN EXPOSED

ITS IMPORTANT TO
,UNEXPOSED AND TOTAL POPULATION ?
UNDERSTANT THAT
When I say smoking is associated with lung cancer this
THE RISK FACTOR
doesn’t mean that every smoker is going to get lung
cancer and doesn’t mean that nonsmokers will not get DOESN’T MEAN
lung cancer too but I will be calculating the rate is CAUSATION  IT
different. MEANS HIGHER
WHEN I DO: PROBABILITY AND

Incidence rate of exposed HIGHER INCIDENCE

WHEN COMPARED
Incidence rate of unexposed
TO OTHER FACTORS
It will give me how many times the probability is higher
in the exposed group than the unexposed group

 So first to identify if this factor is a risk factor or not BY THIS ratio :

And we can estimate the incidence of the disease with the exposed group
and also in the unexposed group and also in the total population  Only If
we select the population randomly.

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 Cohort study
Analysis from cohort disease :
How to analyze the result?

 If the measurement was continuous variable Ex hemoglobin

 Estimation of the population parameter (mean /rate) of the outcome

 If the measurement was categorical (it will happen or it will not)

Then estimate the incidence of the disease in exposed, unexposed and
total population

Ex : the incidence of lung cancer in smokers , nonsmokers

and total population

Another Ex : the incidence of dental caries in children who

brush their teeth and in children who don’t and in the total
population

‫حتى نقدر نسبة حدوث المرض في كل مجموعة‬

 Qualitative association between disease and risk factor ( Chi- squared

test )
The chi –squared test gives me the answer of the question: is this factor
a risk factor or not?
You have to answer with yes or no according to this chi-square

NOTE >>> chi-square test is qualitative<<<

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Cohort study
Quantitative risk assessment :
 RR (relative risk): incidence in exposed / incidence in unexposed

Ex : incidence of exposed = 20% , incidence of nonexposed = 5%

Then RR = 20 / 5 = 4 ,, 4 * 100 = 400%

This means that the probability of this disease in those who are exposed
to this factor is 4 times higher than the unexposed

** if the result was = 1 (rate of exposed = rate of unexposed) then 

then there is no association therefore it’s not a risk factor

 RD (risk difference) = incidence of exposed – incidence of unexposed

From the previous example
The risk difference = 20% - 5% = 15%
15% is called the excess rate in the exposed group that are attributed
due to the exposure
Risk factor ‫ انصابو بسبب تعرضهم لل‬%20 ‫ من ال‬%15 ‫يعني‬

 Attributable risk:
From the previous example:
20% were exposed, 5% of unexposed to the risk factor (risk factor  not
brushing) within 6 months
5% developed dental caries in children who brush their teeth daily,
20% developed dental caries in children who don’t brush their teeth
daily they have risk factor which is not brushing
Now 20% - 5% = 15%
If I again divide the result with the incidence of exposed
 15% / 20% = 75%
It means that 75% of the cases who have dental caries in the exposed
group (who didn’t brush their teeth daily) is due to the exposure to
the risk factor (didn’t brush their teeth daily)Lung cancer example on
the next page will explain better!
 Odds ratio : we will talk about it later on

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Cohort study

The same with the lung cancer:

The incidence in smokers = 20 %

The incidence in nonsmokers = 5%

(remember that not all 20% of lung cancer happened because of the smoking,
otherwise we will have 0% incidence in non-smokers)

Here I want to answer what is the % of the cases of the lung cancer in smokers
is attributed to the risk factor which is smoking?

The answer: 20%- 5% = 15 %

15% / 20 % = 75%  the % is 75%

So 75% of the lung cancer cases of smokers were able to be prevented, if the
person was not a smoker.

and as this % is getting higher, the risk factor here is playing a greater role in
this disease

If I multiply the % by the number of exposed people it will give me how any
cases could be saved if they stayed away of the risk factor.

Good Luck