Case-Control

CASE-CONTROL DESIGN
Figure: Case-control
Retrospecti-

vely studied
Any risk
factors?
CASES
A group with
effect (+)
Population
Effect -
Effect +
CONTROL
A group without
effect (-)
EXPOSURE
UNEXPOSURE
EXPOSURE
UNEXPOSURE
Onset of study
Matching, random
Direction of inquiry
OR
Od
Od
INDICATION
To study relationship between
risk factor and disease
Incidence of the disease in
population is very rare

Procedure
1. Start with case definition people who
are suffering from disease X
2. Definition of of control people who are
not suffering from disease X
3. Study the possibility of risk factors =
exposure
4. Result analysis
CASES
A. Criteria
people with the disease of interest
example:
* TBC, Carcinoma insitu, Pelvic inflammatory diseases or others

The cases may new (incidence) or old cases
(prevalence)


B. Source of cases
* Health Services facilities (Hospital, Puskesmas, Private doctors,
etc) for . years (time period)

* Direct Survey to the community
at one moment

Definition
A group of people, who do not have the
disease of interest
Selection of Control
A. Condition
* Representative to the population
* Similar with cases (comparable)

B. Source of control
* Health services facilities
* General population
* The family of cases
* The work friends of cases
C. Methods
* Matching
* Random
Method of Exploration
A. Condition:
Methods used must be similar for cases and
control

B. Source (methods)
* Interview
* records
IV. Result analysis
Incidence rate

Relative Risk

Estimation of RR;
ODDS RATIO


Result analysis
Estimation of RR (ODDS RATIO) will
equal to RR if:
1. Cases are represented precisely
(similar characteristic with cases in a
population) (sample ~ population)

2. So as for control group
3. Disease Incidence in a population
is relatively small in number
* Case-control is to study
diseases with very low incidence.

* If the incidence is high choose COHORT
Result analysis
Calculation for Odd Ratio

Exposed Unexposed Total
Cases A B A+B
Control

C D C+D
Total A+C B+D n
OR = (Odd Case)/(Odd Control) = A/C:B/D = AD/BC
Odd Cases = [A/(A+C)]/[C/(A+C)] = A/C
Odd Control = [B/(B+D)]/[D/(B+D)] = B/D
Calculation for CI (OR)
Calculate the confidence interval in
a case-control study:

95% CI = (OR) exp [+ 1.961/A+1/B+1/C+1/D]
page 206 Medical Epidemiology Greenberg
Calculation OR for Matched-paired

Control
Exposed
Control
Unexposed
Total
Case Exposed A B A+B
Case
Unexposed
C D C+D
Total A+C B+D n
OR = B/C
For matched-pair case control study
Concordant pair
95%CI = (OR) exp[+1.96 1/B+1/C]
Interpretation of OR
Form a case-study of smoking and CHD found:
Odd for Case = 10
Odd for Control = 2
OR = 10/2 = 5
Interpretation:
The probability of cases smoking 5 time
greater then control, there for it can be
concluded that smoking increased the
likelihood of developing CHD 5 time greater
then non smoking
Interpretation of 95% CI (OR)
Form a case-study of smoking and CHDfound:
Odd for Case = 10
Odd for Control = 2
OR = 10/2 = 5
95% CI = 2.9 ; 19.1
Interpretation:
If we repeat the same study over 100 time,
95% of the studies will have OR between 2.9
to 19.1, there for it could be concluded that
smoking increase the CHD Risk.
STUDI KASUS-KONTROL
Bias in a case-control study
The advantages of Case-control study
a. Selection bias
b. Information bias
c. Confounding bias
a. Good for rare cases with long latent phase
b. Relatively inexpensive
c. Need smaller samples
d. Possibility to study several risk factors at
once
STUDI KASUS-KONTROL
The weakness of Case-control
a. Incomplete medical records and bias recall of
risk factor
b. Difficult to verify the information
c. Difficult to find a control group who comparable
precisely with cases
d. Cannot gain the incidence rate
e. Cannot be apply to study more than one
dependent variable (effect/disease)