Cohort Study Notes:

In statistics and demography, a cohort is a group of subjects who have shared a

particular event together during a particular time span (e.g., people born in Europe
between 1918 and 1939; survivors of an aircrash; truck drivers who smoked
between age 30 and 40).
- Cohorts may be tracked over extended periods in acohort study. The
cohort can be modified by censoring, i.e. excluding certain individuals from
statistical calculations relating to time periods (e.g. after death) when their
data would contaminate the conclusions.
The term cohort can also be used where membership of a group is defined by some
factor other than a time-based one

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- for example, where a study covers workers in many buildings, a cohort

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might consist of the people who work in a given building.

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Demography often contrasts cohort perspectives and period perspectives.
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For instance, the total cohort fertility rate is an index of the average
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completed family size for cohorts of women, but since it can only be known
for women who have finished child-bearing, it cannot be measured for
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currently fertile women.

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- It can be calculated as the sum of the cohort's age-specific fertility rates

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that obtain as it ages through time.

- In contrast, the total period fertility rate uses current age-specific fertility
rates to calculate the completed family size for a notional woman were she
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to experience these fertility rates through her life.

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Analytical study in which a group having one or more similar characteristics (such as
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habit of smoking or a particular disease) is closely monitored over time

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simultaneously with another group (whose member do not smoke or are free from
the disease).

Although more tedious, this method is used where case study approach is
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not feasible, creates too many statistical problems, or generally produces
unreliable results. Also called follow up study.

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 Types of Cohort Studies
The simplest cohort design is prospective, i.e., following a group forward in time, but a
cohort study can also be 'retrospective'. In general, the descriptor, 'prospective' or
'retrospective' indicates when the cohort is identified relative to the initiation of the
study.
1. Prospective cohort (concurrent; longitudinal study) -An investigator identifies the
study population at the beginning of the study and accompanies the subjects through
time. In a prospective study, the investigator begins the study at the same time as the
first determination of exposure status of the cohort. When proposing a prospective
cohort study, the investigator first identifies the characteristics of the group of people
he/she wishes to study. The investigator then determines the present case status of
individuals, selecting only non-cases to follow forward in time. Exposure status is
determined at the beginning of the study.

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 Problems: loss to follow up; differential nonresponse; loss of funding support;
continually improving methods for detecting exposure (leading to greater

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misclassification than would be expected in current practice)
Examples: Framingham Study; Nurses Health Study; National Health and

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Nutrition Examination Study Follow up Study (NHANES Followup) These are all
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studies where case status was determined and current cases eliminated from the
study. Exposure was then measured in non-cases who were followed over a
period of time until reaching an endpoint. A member of the cohort reaches the
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endpoint either by dying, becoming a case, or reaching the end of the study
period. A subject can also be lost to follow-up over the course of the study. The
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investigator progresses through time with the subjects in a prospective cohort

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study. Such a study may also be called a longitudinal or a concurrent study as

opposed to a retrospective study.
2. Retrospective cohort study (historical cohort; non-concurrent prospective cohort) -
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An investigator accesses a historical roster of all exposed and nonexposed persons and
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then determines their current case/non-case status. The investigator initiates the study
when the disease is already established in the cohort of individuals, long after the
measurement of exposure. Doing a retrospective cohort study requires sound data on
exposure status for both cases and noncases at a designated earlier timepoint.
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