Types of Studies

Cohort (Longitudinal) Studies

Observational studies in which an investigator determines the
exposure status and then follows them over long periods of time. There
is a cutoff point used to separate groups. In prospective, all individuals
must be free of the outcome that is being examined.
Studies where the researcher passively observes events without
determining assignment of exposure are observational studies
Prospective Cohort Studies (more expensive & longer)
Exposure and subsequent outcome status is ongoing
Retrospective Cohort Studies (cheaper & quicker)
Historical information on exposure status and subsequent outcome
What is a Risk Ratio?
The probability of an event occurring in an exposed group vs. the
probability of the event occurring in a non-exposed group.
Example: The probability of developing lung cancer is 25% in smokers
and 1% in non-smokers
RR = [a/(a+b)] / [c/c+d] = [25/(25+75)] / [1/(1+99)] = 25
Relative risk > 1 is increased risk ; relative risk < 1 is decreased risk
Table 83. Advantages and Disadvantages of Cohort Studies.
Advantages
Disadvantages
Direct calculation of risk ratio (relative risk) Time consuming
May yield information on the incidence of Often requires a large sample size
disease
Clear temporal relationship between
Expensive
exposure and disease
Particularly efficient for study of rare
Not efficient for the study of rare
exposures
diseases
Can yield information on multiple
Losses to follow-up may diminish
exposures
validity
Can yield information on multiple
Changes over time in diagnostic
outcomes of a particular exposure
methods may lead to biased results
Minimizes bias
Strongest observational design for
establishing cause and effect relationship

 Case-Control vs. Cohort

Ultimately, case-control is when you start with patients who have the
outcome or who do not have the outcome of choice and then you
compare their exposure histories. With cohort studies, you are looking
at people who have either been exposed or non-exposed and use that
information to study the outcomes.
When the outcome is rare, you want to use case-control studies
because that way you can start with a particular number of people and
examine exposure histories as opposed to having to hope someone
develops it over a longitudinal study
When the exposure is rare, you want to use cohort studies because it
is much more efficient to start by identifying people who have been
exposed (ie. Treated) and not exposed (ie. Untreated) and follow them
until the occurrence of a disease occurs
Odds Ratio
Odds ratio = Odds of case exposure / Odds of control exposure
= (A/B) / (C/D)
= (AxD) / (BxC)
Example: We want to see who is likely to use the ER more (thats the
outcome). 23 of 58 patients exposed to the drug use the ER parking
lot. Only 7 of the 93 controls use the parking lot though.

Odds ratio = (A x D) / (B x C)
= (23 x 86) / (36 x 7)

Table 99. Advantages and Disadvantages of Case-Control Studies.

Advantages

Disadvantages

Efficient for the study of rare diseases

Risk of disease cannot be estimated directly

Efficient for the study of chronic diseases

Not efficient for the study of rare exposure

Tend to require a smaller sample size than other

More susceptible to selection bias than alternative designs

designs
Less expansive than alternative designs

Information on exposure may be less accurate than that available in

alternative designs

May be completed more rapidly than

alternative designs

With cohort studies you need to keep everyone in for as long as you can.
Lack of follow-up is a huge source of bias. With cohort studies you are
looking at exposures, and following forward in time to see if an outcome

results. With case-control though, you select people with or without the
outcomes and look at exposure histories.
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