Epidemiology

By

M&E OFFICER ,NMCP, MINISTERY OF HEALTH

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 Methods of
epidemiological studies
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 Study design

Generally, there are two main categories of study design:

observational study, and experimental or intervention study.
In the observational study, the investigators
stand apart from events taking place in the study, they simply
observe and record.
In the experimental or intervention study, the investigators
introduce an intervention and observe the events which
take place in the study. 
 Epidemiological studies
Epidemiological
studies

Observational Experimental
studies studies

analytical descriptive clinical triad field triad

unit of study unit of study

case report
populations individuals

Ecological unit of study unit of study

studies two groups one group

Follow-up (or cross-

Case-control
cohort sectional
studies
studies studies
 :Observational study

Are studies which describe the distribution of disease

in human populations and investigate possible a
etiological factors to explain that distribution. The
investigators have no control over who is and who is
not exposed to the factor under study.
This type of study include Cross-sectional study, case-control study and cohort
study
Cross-sectional Design
factor present
No Disease
factor absent
Study
population
factor present
Disease
factor absent

time
Study only exists at this point in time
 Cross-sectional studies
Cross-sectional studies can be thought of as
providing a snapshot of the frequency of a
disease or other health related characteristics
(e.g. exposure variables) in a population at a
.given point in time
 -:Cross-sectional study

 Are studies in which a defined population surveyed and their

disease or exposure status determined at one point in time
 The prevalence rates of disease in the whole population as
well as in those with and without the exposure under
investigation can be determined
 Cross-sectional studies do not follow individuals over time,
but only look at the prevalence of disease and/or exposure at
one moment in time.

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 Cross-sectional studies

Cross-sectional studies are used to

assess the burden of disease or health
needs of a population and are
particularly useful in informing the
planning and allocation of health
.resources
 Cross-sectional studies

Types of cross-sectional study

Descriptive
A cross-sectional survey may be purely descriptive and
used to assess the burden of a particular disease in a
.defined population
For example a random sample of schools across
London may be used to assess the prevalence of
.asthma among 12-14 year olds
 Cross-sectional studies

Analytical
Analytical cross-sectional surveys may also be
used to investigate the association
.between a putative risk factor and a health outcome
However this type of study is limited in its ability to
draw valid conclusions as to the association between a risk factor and health
outcome. In a cross-sectional
survey the risk factors and outcome are measured simultaneously, and therefore it
may be difficult to
.determine whether the exposure proceeded or followed the disease
.In practice, cross-sectional studies will include an element of both types of design
 Cross-sectional studies

Analysis of cross-sectional studies

In a cross-sectional study all factors
(exposure, outcome, and confounders) are
.measured simultaneously
The main outcome measure obtained from a
:cross-sectional study is prevalence, that is
 Cross-sectional studies

Note:
that for continuous variables such as blood pressure or
weight, prevalence may only be calculated
 Cross-sectional studies
Strengths
 Relatively quick and easy to conduct (no long periods of follow-up).
 Data on all variables is only collected once.
 Able to measure prevalence for all factors under investigation.
 Multiple outcomes and exposures can be studied.
 The prevalence of disease or other health related characteristics are
important in public health for assessing the burden of disease in a specified
population and in planning and allocating health resources
 Good for descriptive analyses and for generating hypotheses.
 Cross-sectional study is often useful at the time of an epidemic investigation.
 Cross-sectional studies
 Weaknesses
 Difficult to determine whether the outcome followed exposure in time or
exposure resulted from the
outcome.
 Not suitable for studying rare diseases or diseases with a short duration.
 As cross-sectional studies measure prevalent rather than incident cases,
the data will always reflect
determinants of survival as well as a etiology.
 Unable to measure incidence.
 Associations identified may be difficult to interpret.
 Susceptible to bias due to low response and misclassification due to recall
bias.
2-Follow-up (or cohort) studies
 Are studies in which people are identified and
grouped with respect to whether or not they have
been exposed to a specific factor? The groups are
followed up overtime to determine whether the
incidence of a particular disease is any greater (or
less) in the exposed group than in the non-
exposed group.
 disease
Factor
Study present no disease
Cohort Design

population
free of
disease Factor disease
absent
no disease
present
future

time
Study begins here
2-Follow-up (or cohort) studies

 
 
Follow-up (or cohort) studies-2
 Follow-up (or cohort)-2
studies
 In general, can investigate the effect of only a limited number of
FACTORS
 Useful for investigating a range of outcomes associated with only
one FACTOR
 Useful for study of rare exposure
 Not suitable for the study of rare diseases
 Follow-up studies are often large and expensive
 May take many years to complete
 Cannot test current hypotheses
 Can measure disease incidence
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RETROSPECTIVE COHORT
 Cohort Study
 Strengths
 Exposure status determined before disease detection
 Subjects selected before disease detection
 Can study several outcomes for each exposure

 Limitations
 Expensive and time-consuming
 Inefficient for rare diseases or diseases with long latency
 Loss to follow-up
 Case-control studies-3

Are studies in which a group of people with a particular disease (the

cases) are compared with a group of people without the disease
(the controls). The purpose of the comparison is to determine
whether, in the past, the cases have been exposed more (or less)
often to a specific factor than the controls
In general, the cases included in a case-control study include
people with one specific disease only But, a case-control study
can provide information on a wide range of possible exposures
that could be associated with that particular disease
 factor present
Cases
factor absent (disease)
Study
Case-Control

population
factor present Controls
Design

(no disease)
factor absent
present
past

time

Study begins here

3-Case-control studies
 

Useful for the study of rare diseases

 
Not suitable for the study of rare exposure
 
Relatively small and inexpensive
 
Takes a short time to complete
 
Can test current hypotheses
 
Cannot measure disease incidence
CASE CONTROL VS. RETROSPECTIVE COHORT
 Case-Control Study
 Strengths
 Less expensive and time consuming
 Efficient for studying rare diseases
 Limitations
 Inappropriate when disease outcome for a specific
exposure is not known at start of study
 Exposure measurements taken after disease
occurrence
 Disease status can influence selection of subjects
 Experimental Studies
 investigator can “control” the exposure
 similar to laboratory experiments except living
populations are the subjects
 generally involves random assignment to groups
 clinical trials are the most well known experimental
design
 the ultimate step in testing causal hypotheses
 Experimental Studies
 In an experiment, we are interested in the
consequences of some treatment on some outcome.
 The subjects in the study who actually receive the
treatment of interest are called the treatment group.
 The subjects in the study who receive no treatment or
a different treatment are called the comparison
group.
 -:Randomized Clinical Trials

-A randomized clinical trial is an experiment with patients as

subjects.
-The goal is to find an effective treatment for a disease or to
evaluate an intervention to prevent the progression of a
disease.

-Randomized clinical trials are often used to evaluate the

efficacy of new drugs against standard treatments or against
placebos.
Experimental Design RANDOMIZATION outcome
Intervention
no outcome
Study
population
outcome
Control
no outcome
baseline
future

time
Study begins here (baseline point)
 Epidemiologic Study Designs

 Randomized Controlled Trials

(RCTs)
 The “gold standard” of research designs
 Provides most convincing evidence of
relationship between exposure and effect
 Randomized Controlled
Trials
Disadvantages
 Very expensive
 Not appropriate to answer certain types of
questions
 It may be unethical, for example, to assign
persons to certain treatment or comparison
groups
 :B- Experimental study design

2- Community Trial:-
 -Is also an experiment, but differs from clinical trials
in that an entire community, rather than an individual
patient (community is the unit of observation).
 Several community trials have been conducted to
evaluate the effectiveness of mass media
campaigns to prevent heart disease, by encouraging
more exercise, less use of tobacco products, and
other lifestyle modifications
The End

Thank You
Dr. Moamer .M. Badi
E mail :- bady_m_90@yahoo.com

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