Epidemiologic Studies

Training of Trainers
Cordillera Regional Health Research and
Development Consortium (CRHRDC)
September 2019

Dr. John Domantay

Trainer
Disclaimer
• This powerpoint presentation was prepared by Dr.
John Domantay as a BRM Trainer for the “Training
of Trainers” Training.
• This is based on the original lecture of Dr. Ofelia
Mendoza for the Philippine Council for Health
Research and Development (PCHRD).
• Some parts have been updated and modified by
Jocelyn M. Erorita-dela Vega, a CRHRDC BRM
Trainor, to suit the characteristics of the learners of
the College of Nursing, University of the Cordilleras.
Outline
• Types of Study Designs

• Descriptive Studies

• Analytic Studies

• Experiments
Study designs can be classified as
either descriptive or analytic.
DESCRIPTIVE ANALYTICAL

Describes Explains

Is more exploratory Is more explanatory

Profiles characteristics of Analyzes why group

group has characteristics

Focuses on “what” Focuses on “why”

Assumes no hypothesis Assumes a hypothesis

Does not require Requires comparisons

comparisons between between groups over
groups or over time time
Study designs can be classified as
either descriptive or analytic.
Designs have a hierarchy based on
validity and statistical power.
These are the types of descriptive
study designs.
Descriptive
Case studies
cross-sectional
and case series
studies

Ecologic
studies
 Case Study/Case Series
A case study, also known as a case report, is an in depth or
intensive study of a single individual or specific group, while a
case series is a grouping of similar case studies / case reports
together.
A case study / case report can be used in the following instances:
•where there is atypical or abnormal behavior or development
•an unexplained outcome to treatment
•an emerging disease or condition
It is an account of interesting
characteristics observed in a group of
subjects.
The subjects do not necessarily
have to be persons.

Organizations Institutions

Political units
It involves subjects seen over a relatively
short period of time.
It does not include control subjects.
It does not involve any research
hypothesis.
The findings lead to the
generation of a hypothesis.
Descriptive cross-sectional
studies/Prevalence surveys
It involves the occurrence and
distribution of the disease of interest.
 Prevalence is usually computed for
specific categories of variables.

Person Place

Time
To characterize the disease, the prevalence is usually computed for
specific categories of variables related to person (sex, age,
occupation), place (type of terrain, geographical location), and time (
month, season).
It describes patterns of health service
utilization and compliance.
 Ecologic Studies
Most epidemiological investigations of etiology are
observational. They look for associations between the occurrence
of disease and exposure to known or suspected causes. In
ecological studies the unit of observation is the population or
community. Disease rates and exposures are measured in each of a
series of populations and their relation is examined. Often the
information about disease and exposure is abstracted from
published statistics and therefore does not require expensive or time
consuming data collection.
The unit of observation and
analysis is an aggregate.
The exposure is homogenous in a
population, but differs between
populations.

The exposure
is the same
within the
state or the
country, but
differs
between the
different states
or country.
 Individual measurements of
exposure are impossible.

Because the
data
gathered are
an aggregate
or a
combination
or totality of
separate
units.
It is used as a quick method of
examining associations.
The most serious flaw is the
ecological fallacy.

Ecological fallacy, is a
failure in reasoning
that arises when an
inference is made
about an individual
based on an
aggregate data for a
group. Aggregation
of data results in the
loss or concealment
of certain details of
information.
Characteristics of individual units are
incorrectly attributed to individuals.
These are the types of descriptive
study designs.
Descriptive
Case studies
cross-sectional
and case series
studies

Ecologic
studies
Outline
• Types of Study Designs

• Descriptive Studies

• Analytic Studies

• Experiments
These are the types of analytic
study designs.

Cohort Case-control
studies studies

Cross- Experimental
sectional studies and
studies clinical trials
These types of studies have also been referred to as
natural experiments in that they are designed to take
advantage of exposure-disease relationships that
occurs naturally in human populations.
The first three are considered
observational studies.

Case-control
Cohort studies
studies

Cross- Experimental
sectional studies and
studies clinical trials
In observational studies, relationships
between disease and exposure are
investigated.
 Cohort Studies
This is a type of longitudinal study – an approach that
follows research participants over a period of time
(often many years).

It is done to build an understanding of what factors

increase or decrease the likelihood of developing the
disease.
This is the design of a cohort
study.
Data will be collected after a
follow-up period.
This is an example of a cohort study
(hypertension and physical activity).
Advantages of Cohort Studies
It may yield information on the
incidence of disease.
How many new cases
will arise from the
exposure, relative to
time?
It is possible to compute for the
relative risk.
Relative risk is a ratio of the
probability of an event occurring in the
exposed group versus the probability
of the event occurring in the non-
exposed group. For example, the
relative risk of developing lung cancer
(event) in smokers (exposed group)
versus non-smokers (non-exposed
group) would be the probability of
developing lung cancer for smokers
divided by the probability of
developing lung cancer for
nonsmokers. The relative risk does not
provide any information about the
absolute risk of the event occurring,
but rather the higher or lower
likelihood of the event in the exposure
versus the non-exposure group.
The temporal relationship between
exposure and disease is clearly
defined.

Exposure Outcome

A Temporal Relation is an ordered relation between a time

expression and an event mention, which can have one of
the following three types: “before”, “after”, or “overlap”.
(TIME)
It is efficient for studies with rare
exposure factors.
It is the strongest observational
design for establishing cause-effect.

Cause Effect
Disadvantages of Cohort
Studies
It is time consuming.
It often requires a large sample
size.
It is expensive.
It is not efficient for the study of
rare diseases.
Losses to follow-up may diminish
validity.
Changes over time in diagnostic
methods may lead to biased results.
There are two types of cohort
studies.
 Case-Control Studies

In the case-control study, patients who have developed

a disease are identified and their past exposure to suspected
etiological factors is compared with that of controls or
referents who do not have the disease. This permits
estimation of odds ratio (but not of attributable risks).

This type of study is concerned with the frequency and

amount of exposure in subjects with a specific disease (cases)
and people without the disease (controls).
This is the design of a case-control
study.
Exposure data will be collected
retrospectively by interviews and/or
records review.
This is an example of a case-control
study. (hypertension and physical
activity level)
Advantages of Case-Control
Studies
It is feasible when dealing with
rare diseases.
It requires a smaller sample size
than a cohort study.
There is little problem with
attrition.
Disadvantages of Case-Control
Studies
Incidence rates and attributable
risks cannot be computed.
The temporal sequence between
disease and exposure may be a
problem.

Disease Exposure
There is a big chance for bias in the
selection of cases and controls.
It is difficult to obtain information on
exposure if the recall period is too
long.
There are two kinds of case-
control studies.

Population- Hospital-
based based
Population-based Case-Control
Studies
Cases and controls are sampled
from a defined population.
The source population is better
defined.
Cases and controls come from the
same source population.
Exposures of the controls are more
likely to reflect those of persons
without the disease.
Hospital-Based Case-Control
Studies
• Cases are admitted in a
particular hospital.
• Controls are admitted with other
conditions but with no evidence of the
disease of interest.
• Subjects are more accessible.
• Subjects tend to be more
cooperative.
• Background characteristics of cases
and controls may be balanced.
It is easier to collect exposure
information from medical records or
biological experiments.
 Cross-Sectional Studies
• This is a type of research design in which you collect
data from many different individuals at a single point in
time.
• Variables are observed without influencing them.
• It is used to describe what is happening at the present
moment, and to determine the prevailing
characteristics in a population at a certain point in time.
• The investigator measures the outcome and the
exposure in the study participants at the same time.
This is the design of a cross-
sectional study.
This is an example of a cross-
sectional study (hypertension and
physical activity).
Advantages of Cross-Sectional
Studies
It is less time-consuming and less
costly.
It serves as the starting point in
prospective cohort studies.
It allows the management of risk,
although the estimate is not precise.
It allows the management of risk,
although the estimate is not precise.
Disadvantages of Cross-
Sectional Studies
It does not enable the direct
estimation of risk.
It is often difficult to establish the
temporal sequence of exposure and
disease.

Exposure Disease
Epidemiologic Studies
Training of Trainers
Cordillera Regional Health Research and
Development Consortium (CRHRDC)
September 2019