Professional Documents
Culture Documents
Renjulal Yesodharan
Meaning
Cohort studies are a particular kind of trend
major components.
(1) A defined population
(2) Exposure status (3) Outcomes.
Components
cohort.
A cohort may be most generally defined as a
band or a group
Rothman and Greenland observe that In
Cohort
Those people within a geographically or
otherwise
delineated
population
who
Exposure or non-exposure
Health sciences cohort designs normally
non-exposures
can
span
range
of
conditions.
An
exposure
can
include
personal
different
ways:
intensity,
duration,
Outcomes
In a cohort study, not all hypothesized
outcomes actually occur. Sometimes the hypotheses, null hypotheses, or alternative hypotheses fail to predict what turns out to be a completely unexpected outcome.
finding that moderate amounts of alcohol might have beneficial health effects. Another cohort study on the risk of developing Parkinson disease noted the possible preventive effect of caffeine. In other instances, cohort studies yield no observed outcomes.
interest is (are)
incidence
of
disease
(cohort
studies
measure
mortality,
disease
health
incidence
status, and
directly),
certain
to a risk factor.
Cohort
studies
include
one
at
to
least
two
observation
points:
determine
calculation of disease rates, which cannot be obtained with only a single time point of observation.
In cohort studies, the individual forms the unit of
of primary data, although secondary data sources are used sometimes for both exposure and disease assessment.
Example -1
A cohort study of CHD was initiated in 1948 in
Framingham, Massachusetts.
When the study commenced, the town had a
population of 28,000; the study design called for a random sample of 6,500 from the targeted age
range
of
30
to
59
years.
This
sample,
representative of the population, was followed subsequently for changes in risk factors and incidence of disease.
indirectly(fraction).
In a population-based cohort, exposures are
unknown until the first period of observation when exposure information is collected.
After
administration of biologic
of
collection
examinations, or physiologic testing, the cohort can be divided into two or more exposure
comparison group.
based
studies
has
benefits
Example 1 The experiments with animals provided evidence that exposure to lead causes long-term neurologic toxicity. The amounts of lead used were much greater than those found in most human exposures. Certain occupational groups, however, such as those involved in battery production, might have sufficient occupational exposure to incur significant health risks. Although one could consider using a case-control study, because the proportion of the population employed in the battery manufacturing industry is low, there would likely be few cases or controls with exposure in the study sample. An alternative approach might be to assemble an exposure-based cohort of employees in battery production factories, quantify levels of exposure using job titles and assignments, and determine incidence rates of neurotoxicity.
Multiple occurrences:
Of disease outcome
health/disease
Of transitions between functional states
Level of a marker for disease or state of health Change in functional/physiologic/biochemical/ anatomical marker for disease or health
Rate of change -Patterns of growth and/or decline -"Tracking" of markers of disease/health Change in level with time (age)
(Tager Ib. Outcomes in cohort studies Epidemiologic review: 1998. 20. P16)
COHORT DESIGNS
The basic feature of all cohort studies is
variations
are
prospective
and
prospective
cohort
study
is
purely
prospective in nature and is characterized by determination of exposure levels at baseline (the present) and follow-up for occurrence of disease at some time in the future. The sampling strategy may be population-based or defined by a special exposure of interest.
study hypothesis
(e.g.
alcohol use, occupation, coping skills, and quality of life, each of which can be assessed with a few specific items or a comprehensive battery of items).
control by the investigators than is the size of a retrospective cohort (Cohort studies that rely on historical records are sometimes fixed in size).
Biological and physiological assays can be performed with
decreased concern that the outcome will be affected by the underlying disease process. (Examples include
indoor radon levels, electromagnetic field radiation, cigarette smoke concentration, or chlorination byproducts in the water
cohort studies, investigators must wait for cases to accrue while conducting such a study. Depending upon the size of the cohort and the prevalence of a disease in the population, several years could elapse before meaningful analyses are feasible.
Example.1:
Sellers and colleagues performed a follow-up beginning in the year 1991 of a cohort of 426 families originally ascertained
Example2:
Hartmann and colleagues18 at the Mayo Clinic, using an
index of surgical procedures, were able to construct a cohort of women who received prophylactic mastectomy between 1963 and 1986. Details were available in the medical record on type of surgery, age at surgery, family history of cancer, and complications following surgery. Follow-up through 1997 was performed to identify subsequent occurrences of breast cancer. Analyses based on a median 14 years of follow-up were possible, even though the actual study took less than five years to complete.
design
that
(to
makes
use
of
both
retrospective
determine
baseline
a is the number of persons who are exposed to factors and have the disease, b is the number of persons who are not exposed to the factors and not have the disease, c is the number of persons who are exposed
The risk of disease in the individuals exposed and unexposed to the factor of interest in the population can be estimated in the same way.
(rate) of disease among the exposed is no different from the risk of disease among
Data Collection and Data Management An axiom of epidemiologic research design is that larger studies necessarily are more demanding than smaller ones with regard to challenges in data collection and data management. Coordination of activities in the field is especially complex when multiple sites are necessary for recruitment. Additional challenges may arise from data entry, especially if individual sites enter their own data for transmittal to the coordinating center. In these situations, explicit protocols for quality control (e.g., double entry of data, and scannable forms) should be considered in the design and implementation stage.
elaborate
data-management
systems
to
can be incredibly challenging and should be considered when staffing needs are being defined. Challenges arise from data
collected from multiple sources, merging of files, and "cleaning" of data files.
Follow-up Issues
The value of cohort studies can be realized only
Sufficiency of Scientific Justification There should be considerable scientific rationale for a cohort study. This rationale should be grounded on prior research from various perspectives: study designs other than cohort studies; several different investigators; and several different study populations. Additional justification for cohort studies may come from laboratory experiments or animal studies.
of outcome
It is possible to measure the incidence/risk of
disease directly.
It
is possible to collect very detailed information on exposure to a wide range of factors. It is possible to study exposure to factors that are rare Exposure can be measured at a number of time points so that changes in exposure over time can be studied. There is reduced recall and selection bias compared with Case-control studies
Disadvantages of cohort studies In general, cohort studies follow individuals for long periods of time, and are therefore costly to perform. Where the outcome of interest is rare, a very large sample size is needed. As follow-up increases, there is often increased loss of patient as they migrate or leave the study, leading to biased results
REFERENCES Glenn ND. Cohort analysis. Beverly Hills, CA: Sage Publications,
1977:8 Ryder, N.B. (1965). The cohort as a concept in the study of social change. American Sociological Review 30(6): 843-861 Bgaud BB. in Dictionary of Pharmacoepidemiology, John Wiley & Sons, Ltd, Chichester, UK. 2000: 36. Friis R, Sellers T. Epidemiology for Public Health Practice. Gaithersburg, MD: Aspen Publishers, Inc. Melnyk B M, Fineout, Overholt E. Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice (2nd edition). Philadelphia: 2011. Petrie A Sabin C. Medical statistics at a glance, 2nd ed, Blackwell Science, 2005. Riegelman R K. Studying a study and testing a test- how to read the medical evidence. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC128954/