ANALYTICAL METHOD OF EPIDEMIOLOGY

INTRODUCTION
Epidemiology is the study of distribution and determinants of health related states or events in
specified populations and the application of this study to the control of health problems. There are
many methods of epidemiology based upon the type and approaches of research studies.

Methods of
Epidemioly

Observational Experimental

Randomized Community
Descriptive Analyical Field trial
control trial trial

Cross
Cohort Case control Ecological
sectional

DEFINITION
It is a type of observational study in which analysis is made to study the relationship between disease
and other condition with different variables. In this study the subject of interest is the individual with in
the population.

TYPES OF ANALYTICAL STUDY

There are four types of analytical studies. They are:

1. Ecological or co-relational
2. Cross sectional or prevalence
 3. Case-control or Case reference
4. Cohort or follow up

Mainly the last two are considered more distinct methods of analytical epidemiology.

ECOLOGICAL OR CO-RELATIONAL STUDY

Groups of population of different countries or geographical areas with different

characteristics and values of variables are compared with reference to the frequency of
occurrence of a disease associated with differing values of a variable may point towards
association and possible cause and effect relationship.

CROSS-SECTIONAL OR PREVALENCE

It is a type of observational study that analyzes damta from a population, or a

representative subset, at a specific point in time—that is, cross-sectional data. Cross-
sectional studies differ from case-control studies in that they aim to provide data on the
entire population under study, whereas case-control studies typically include only
individuals with a specific characteristic, with a sample, often a tiny minority, of the rest
of the population.

CASE CONTROL/ CASE REFERENCE (RETROSPECTIVE STUDY)

It is used to test causal hypothesis. There are two existing groups differing in outcome are identified
and compared on basis of some supposed causal attributes. They are often used to identify factors that
may contribute to a medical condition by comparing subjects who have that condition or disease. The
features of case control study are

i. Before the initiation of study, the disease has occurred due to the exposure to infectious
agents.
ii. The study proceeds backward that is from effect (present) to cause.The study proceeds to
find out association and cause effect relationship
iii. Case control study has one control group. It involves two population
 Case: Individual with particular disease. This is the group of sample exposed to the aspect
under study. For e.g- addiction, drug exposure, radiation, occupational exposure.
 Control: Individuals without particular disease. This is the comparison group has no exposure
to the aspects.
iv. Case control study also called retrospective studies
 v. Presence of control or comparison group is essential to find out or reject the finding or
influence.

Steps for Conducting Case- Control Study

The steps for conducting case control study are:

1. Selection of cases and control

2. Matching
3. Measurement of exposure
4. Analysis and interpretation
1. Selection of case and control: The cases and control on which the study is conducted need to
be carefully selected.
a. Selection of cases: The criteria are
 There should be clear definition of a case.
 The definition of case should meet diagnostic(based on stage of disease along with specified
signs and symptoms) and eligibility criteria.(only newly diagnosed cases with in a specific period of time)
 Diagnostic criteria should be same throughout the studies.
 The cases can be taken from hospital or general survey.
b. Selection of control: The criteria are:
 The person should be free from disease
 Except disease other criteria like age, sex, occupation etc. should be same as cases and they
should be selected from same population as the case
 Controls can be selected from hospitals, relatives, neighbors and general population etc.
2. Matching: It is defined as the process by which we select controls in such a way that they are
similar to cases with regard to certain demographic variables. If the cases and controls are not matched
properly, then the result can be confounded and the factors which can distort the results are
confounding factors.
3. Measurement of Exposure: The information about exposure should be obtained both from
cases and controls by using the same method like interview and questioner.
4. Analysis and interpretation: The data collected need to be analyzed in order to get the result.
Analysis is done to find out the following:
A. Exposure rate: It can be calculated from cases and control i.e. the frequency of exposure in
both cases.
In cases exposure rate is the ratio of the number of individual who become cases after exposure to
suspected etiological factors to total number of cases.
In controls, exposure rate can be calculated by the number of individuals who did not get the disease
even after exposure to suspected etiological factor to the total number of individual who were without
the disease.
 B. Estimation of Risk: Estimation of disease risk associated with exposure is obtained by an index
known as relative risk or risk ratio which is defined as the ratio between the incidence of disease
among exposed persons and incidence among nonexposed.
Estimation Risk=Incidence among exposed/ Incidence among nonexposed
Odd ratio: From a case control study odd ratio can be derived which is the measure of strength of the
association between risk factors and outcomes.

Advantages of Case Control Study

1. Relatively easy to carry out.

2. Rapid and inexpensive
3. Require comparatively few subjects
4. Particularly suitable to investigate rare diseases or diseases about which little is known. A
disease which is rare in the general population such as leukemia in adolescent may not be rare in the
general population.
5. No risk to subjects
6. Minimal ethical problems.

Disadvantages

1. Problem of bias e.g.it relies on memory or past records the accuracy of which may be
uncertain.
2. Selection of an appropriate control group may be difficult.
3. We cannot measure incidence and can only estimate relative risk.
4. Do not distinguish between causes and associated factors.
5. Not suited to the evaluation of therapy or prophylaxis of disease

COHORT STUDY(PROSPECTIVE STUDY)

A cohort is a group of people who share a common characteristic or experience within a defined
period (e.g. who are exposed to drug or vaccine or pollutant, or undergo a certain medical procedure).
Thus a group of people who were born on a day or in a particular period, e.g.1948, form a birth cohort.
Features of cohort studies are:

 Cohorts are identified prior to the appearance of the disease under investigation
 The study groups so defined are observed over a period of time to determine the frequency
of disease among them.
 The study proceeds forward from cause to effect.

STEPS OF COHERT STUDY

Following are the steps of conducting cohort study:

 1. Select study subject
2. Collect data
3. Select comparison group
4. Follow up
5. Analysis
1. Selection of study subject: The study subjects for cohort study can be selected either from
general population or special groups of population.
2. Collect data: The data can be collected by personal interview, questioner, review of record,
medical test, environmental surveys. Data about demographic variables and the factors relate to the
development of the disease should be collected in an appropriate manner which provides clear
information about the exposure of selected factors as well as the degree or extent of exposure.
3. Select a comparison group: A comparison group is selected in order to compare morbidity
and mortality rates. The comparison group can be internal or external.
Internal Comparison: When selection of comparison is from same exposure group but the level of
exposure varies.
External comparison: When information on degree of exposure is not available it is necessary to put
an external control, to evaluate experience of exposed group with nonexposed group.
Comparison with general population: If none is available the mortality experience of the exposed
group is compared with the mortality experience of the general population in the same geographical
area as the exposed people.
4. Follow up: The study need to be followed up depending upon the type of study. It is
sometimes difficult to achieve 100% follow up in detail for full duration of study the reason being the
death, change of residence and migration.
5. Analysis: The data collected is analyzed in order to find out the risk rate and frequency of new
cases in terms of incidence rate. In incidence rate the unit of time should be included. It shoulbd include
new cases, time period, population at risk per 1000 population.

Relative risk= Incidence of disease among exposed/ incidence of disease among non exposed

Attributable risk= Incidence of disease among exposed- Incidence of disease among nonexposed/
Incidence of disease among exposed

Advantages

The advantages of cohort study include:

 Incidence can be calculated.

 Several possible out comes related to exposure can be studied simultaneously.
 This study provides a direct estimation of relative risk.
  Comparison groups are formed before disease develops certain forms of bias can be
minimizedlike misclassification of individuals in to exposed and unexposed groups.

Disadvantages

 It involves a large number of people.

 It takes a long time to complete the study and obtain results.
 It is difficult to keep a large number of individual under medical surveillance
 Lack of experienced staffs , loss of funding , and extensive record keeping are inevitable.
 Selection of comparison group is difficult which are exposed and unexposed segments of
population
 Cohort studies are expensive.
 The study itself may alter peoples’ behavior.

CONCLUSION
Analytical study is important part of descriptive method of epidemiology. It helps to know the
causative factors of disease and its distribution in the population and gives a general idea about the
occurrence of disease.