Therefor, even if an association may be with survival after CHD.

Second, because the presence or

absence of both exposure and disease was determined at the same time in each subject in the study, it
is often not possible to establish a temporal relationship between the exposure and the onset of
disease. Thus, in the example given at the beginning of this section, it is not possible to tell whether or
not the increased cholesterol level preceded the development of CHD. Without information on temporal
relationships, it is conceivable that the increased cholesterol level could have occurred as a result off the
coronary heart disease or perhaps both may have occurred as a result of another factor. If it turns out
that the disease, the association cannot reflecta causa relationship.

Consequently, although a cross-sectional study can be very suggestive of a possible risk factor or risk
factor for a disease, when an association is found in such a study, given the limitations in establishing a
temporal relationship between exposure and outcome, we rely on cohort and case-control studies to
establish etiologic relationships.

CONCLUSION

We have now reviewed the basic study designs used in epidemiologic investigations and clinical
research. Unfortunately, a variety of dufferent terms are used in the literature to describe different
study designs, and it is important to be familiar with the. Table 10-12 is designed to help guide you
through the often confusing terminology.

The purpose of all of these types of studies is to identify associations between exposures and diseases. If
such associations are found, the next step is to determine whether the associations are likely to be
causal. These topics, starting with estimating risk and determining whether exposure to a certain factor
is associated with excess risk of the disease, are addressed in chapters 11 through 16.