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Introduction
All studies involve some descriptive or analytic type of comparison of exposure and disease status. Analytical study design options include: observational or interventional (which one is based on the role of the investigator). There are three basic types of observational analytical study designs:
Cohort studies Case-control studies Cross-sectional studies
Introduction
Specific epidemiological study designs can be used to reveal etiologic (causal) relationships
Second:
From these associations, derive appropriate inferences regarding a possible causal relationship
Analytical Studies
Control and experimental groups Randomized groups
data collected without bias
Cohort Studies
Group by common characteristics Start with a group of subjects who lack a positive history of the outcome of interest yet are at risk for it (cohort).
Think of going from cause to effect.
The exposure of interest is determined for each member of the cohort and the group is followed to document incidence in the exposed and non-exposed members.
Cohort Effect
Changes and variation in the disease or health status of a study population as the study group moves through time. Generation effect
Retrospective - makes use of historical data to determine exposure level at some baseline in the past and then determine subsequent disease status in the present. Restricted - limited exposure, narrow behavior (military, long shore men)
Prospective Studies
Also called
longitudinal concurrent incidence studies
Regardless of which selection approach is used, we are comparing exposed and nonexposed persons.
Major problem with a prospective cohort design is that the cohort must be followed up for a long period of time.
Framingham Study
Designed to study the effect of multiple factors on coronary heart disease (CHD):
age hypertension elevated blood cholesterol tobacco smoking increased physical activity increase in body weight diabetes mellitus
Sampling
Valid, reliable surveys Critical number of subjects
the more, the better
Garbage in, garbage out
Randomize
random selection random assignment
Data Gathering
Person - to - person Drop off questionnaire Mailed to people Telephone interview Newsletter or magazine
Your assignment:
Describe and differentiate between these types of biases.
Expensive Unpredictable variables Results not extrapolated to general population Study results are limited Time consuming/results are delayed Requires rigid design and conditions
Survivorship Studies
Survivorship is the number of persons out of a study population who would survive until a certain time interval has been reached Shows the chance that an event (such as death from cancer) will occur in successive intervals of time once a diagnosis has been made Analysis yields a cumulative probability of surviving the projected time period
For infectious diseases, we use case fatality rate to assess survival For chronic diseases, we use cohort life tables
Survival curves and risk of death for males vs. females based on life tables in California for 1980.
Dip at beginning of life is due to infant mortality rate. As one reaches the later years of life, the survival curve goes down and the risk of death goes up.
To be continued