Analytical studies--

Analytical studies are done in order to find out if an outcome is related to exposure. They can
take the form of observational (we don’t influence the population), as well as
interventional/experimental (we influence the population, e.g.: clinical trials; we give drugs).
There are four main types of analytical studies:
Ecological
The average exposure of a population is compared with the rate of the outcome for that
population. The data is obtained for several populations and the data are examined for the
evidence of an association between outcome and exposure. The measure of association is
usually the correlation coefficient. The unit of analysis is the population, rather than the
individual, therefore the only conclusions we can draw relate to the population. There is no
possibility to make conclusions about the association between exposure and outcome at the
individual level.
Cross-sectional
They measure:
1. Prevalence of exposure together with
2. Prevalence of disease
Information on exposures and disease status are obtained at the same point in time, therefore
these studies involve data collection at a defined time. These studies are easy to be conducted
and are quick and relatively cheap. They are often used where there is no registry of disease, for
example studies of respiratory disease or national health surveys. Cross-sectional
studies measure prevalence, not incidence of disease. Temporal sequence of exposure and
effect maybe difficult or even impossible to determine. They 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. Unlike case-control studies, they can be used to describe
absolute risks and not only relative risks.
Cohort
Cohort studies start with a group of exposed and a group of unexposed individuals. These
groups are then followed up over time and assessed to see who develops the disease. The
incidence rate of disease in the exposed group is then compared to that in the unexposed
group, therefore measuring relative risk (RR). Since we only select subjects by exposure, we can
study several health outcomes at the same time. By properly selecting groups of exposed
people we can study relatively rare exposures. Detailed information on confounding factors can
be collected allowing control for them either in the analysis or design. The disadvantage of
cohort studies is that they can take long time and generally are expensive. For rare diseases, the
number of subjects that need to be studied is often so large (since there is a huge majority likely
not show the disease), as to make cohort study impractical or unfeasible.
Case-Control
Case-control studies are very useful for rare disease (or other rare health events) where cohort
studies would be either difficult or impossible (too large) in order to collect enough events.
Case-control studies compare exposures in disease cases vs. healthy controls from the same
population. Researchers start with outcome (event/disease) and measure prior exposure in cases
and in controls (comparison group). These studies can be used to evaluate many different
exposures and are relatively quick to be conducted. The main weakness is that they can look at
only one outcome. The reliability of the study depends on the choice of controls. Data are
collected retrospectively, therefore they are relatively unreliable. The results are the odds ratio.