Overview of Epidemiological

Study Designs

Types of study designs

Epidemiological studies

Descriptive epidemiology

Population level
studies

Case series
Case reports

Individual level
studies

Cross-sectional
studies

Analytical epidemiology

Observational
studies

Case-control
studies

Prospective
cohort

Intervention
studies

Cohort
studies

Retrospective
cohort

Descriptive epidemiology
Person
Age, Sex, Race, Occupation, Life styles

Place
Inter country variations, Urban vs Rural
differences

Time
Daily trends, Seasonal trends, Cyclical trends

Useful for formulating hypothesis

Correlational Studies
Population level measures
Aggregate measure that summarizes individual
members
Environmental measure that describes
geographical location
Global measure with no analogue at individual
level

Eg: Air pollution and Mortality, HIV

seroprevalence and Needle exchange
programme

Correlational studies
Advantages
Quick and inexpensive
Ability to study wide range of exposures
Understanding the ecological effects

Disadvantages
Not possible to link an exposure to disease at
individual level

Case series and Case reports

Case report
Detailed report of a single patient

Case series
Describes characteristics of number of
patients with a given disease

Eg: Homosexual young men with

Pneumocystis carinii, Routine surveillance
programme suggesting new disease or
epidemics

Case series and Case reports

Disadvantages
Difficult to rule out alternate explanations
because of less sample and absence of
comparison group

Cross-sectional studies
Provide snap shot of population at a single
point of time
Exposure and disease assessment at the
same point
Eg: NFHS surveys, RCH surveys

Cross-sectional studies
Advantages
Highly generalizable results
Less costly
Evidence of valid statistical association for unaltered
exposures
Health status / health care need assessment

Disadvantages
Cannot distinguish temporal sequence of exposure
and disease
Affected by factors influencing prevalence

Case-Control Studies
Assess

Select

Exposure
Cases
No Exposure

Exposure
Controls

No Exposure

Case control studies

Advantages

When aetiology is unknown

Less time and money
Rare diseases and diseases with long latent periods
Dynamic population

Disadvantages
Difficult to establish temporal sequence
Rare exposures
Greater chance of bias

Cohort studies
Select

Assess
Diseased

Exposed
Not Diseased

Diseased
Unexposed
Not Diseased

Cohort studies
Prospective
Exposed and Unexposed populations followed
into future for the development of outcome

Retrospective
Exposure and outcome have already occurred
Basic study design is always from exposure to
disease

Cohort studies
Advantages

Rare exposures
Direct estimation of risk
Less chance of Bias (Prospective)
Multiple effects of a single disease
Well defined temporal sequence

Disadvantages

Time consuming costly (Prospective)

Rare outcomes / long latent periods (Prospective)
Bias (Retrospective)
Poor information on exposures and outcomes
(Retrospective)

Intervention studies
Investigator assigns exposure to the
participants
Study design is from exposure to outcome
Ethical problems for hazardous exposures
Studied by attempts to eliminate the
exposures

Intervention studies
Advantages
Most reliable evidence in epidemiological
research because the exposure is randomly
assigned
Randomisation controls the effects of the risk
factors not considered at the time of the study.