Cross sectional study

Associate Professor  Dr. Wongsa Laohasiriwong

Faculty of Public Health, Khon Kaen University
May 15,2017
 Cross sectional Study
 A cross-sectional study

◦ A type of observational study

◦ The investigator has no control over the exposure of interest.
 It involves

◦ Identifying problems in a defined population at a particular

point in time.
◦ Measuring a range of variables on an individual basis
 e.g. include past and current dietary intake
at the same time measuring outcome of interest
 e. g. Exercise and obesity PR
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Cross sectional Study
 Measurement of exposure of interest and outcome of

interest is carried out at the same time (e.g. Obesity

and Hypertension)
 There is no in-built directionality as both exposure

and outcome are present in the study subject for

quite same time.

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 Type of Cross-sectional study
 Type of Cross-sectional study
◦ Descriptive Cross Sectional Study
◦ Analytical Cross Sectional Study
◦Or Both

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Descriptive Cross Sectional Study
Descriptive Cross Sectional Study
 At descriptive level, it yields information about a single
variable, or about each of number of separate
variables in a study population
Analytical Cross Sectional Study
Analytical Cross Sectional Study
 At analytic level, it provides information about
the
presence and strength of associations between
variables, permitting testing of hypothesis
 Structure of
Cross-Sectional Study

Disease/Outcome

Risk factor
 Analytical study
(Cohort, Case-Control And Cross-sectional )
Cohort
Exposure Outcome
Risk Factor Effect
Case-Control

Past Future
Cross-Sectional
Exposure & Outcome
Steps in Cross-sectional study

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 Specifications:
Designing inclusion and exclusion criteria

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 Cross-Sectional Study
Advantages
 Cheap and quick studies.
 Data is frequently available through current records or

statistics.
 Ideal for generating new hypothesis.

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 Cross-Sectional Study
Advantages
 Good design for hypothesis generation
 Can estimate overall and specific disease prevalence
and sometimes rates
 Can estimate exposure proportions in the population
 Can study multiple exposures or multiple outcomes or
diseases
 Cross-Sectional Study
Disadvantages
 The importance of the relationship between the cause

and the effect can not be determined.

 Temporal weakness:

◦Can not determine if cause preceded the effect or the

effect was responsible for the cause.

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 Cross-Sectional Study
Disadvantages
 Impractical for rare diseases
 Not a useful type of study for establishing causal
relationships
 Confounding is difficult to control
 No control over sample size for each exposure by
disease subclass
 Cross-Sectional Study
Disadvantages
 Problems with temporal sequence of data
 hard to decide when disease was actually acquired
 disease may cure the exposure
 miss diseases still in latent period
 recall of previous exposure may be faulty
 Selection Sample

Population

Selected Sample

Risk factor Risk factor No risk factor No risk factor

Disease present No disease Disease No disease
 Sample Selection
 A good way to produce a valid sample would be to randomly

select people from the electoral role and invite them to complete a
questionnaire.
 In this way the response rate is known and non-responders can

be identified.
 However, the electoral role itself is not an entirely accurate

reflection of the general population.

 Sample Selection
 Any study with a low response rate can be criticized because it
can miss significant differences in the responders and non-
responders. At its most extreme all the non-responders could be
dead!
 Strenuous efforts must be made to maximized the numbers who
do respond.
 The use of volunteers is also problematic because they too are
unlikely to be representative of the general population.
 Sample Selection
 A census is another example of a cross sectional study.
 Market research, organizations often use cross sectional studies

(such as opinion polls).

 This entails a system of quotas to ensure the sample is

representative of the age, sex, and social class structure of the

population being studied.
 Sample Selection
 However, to be commercially viable they are convenience
samples—only people available can be questioned.
 This technique is insufficiently rigorous to be used for medical,
public health and other academic research.
 Data Collection

The kinds of questions that can be addressed using

cross-sectional data.
 Many cross sectional studies are done using questionnaires.
 Alternatively each of the subjects may be interviewed.
 Data collection

Questionnaire Interview
 Cheap  Expensive
 Low response rate  High response rate
 Large sample size  Small sample size
Cross sectional studies for prevalence
• Is not defined by a time interval and is therefore
not a rate.
• It may be defined as the number of cases of a
disease (problem) that exist in a defined
population at a specified point in time.
Example : Cross sectional studies for prevalence
 Example Table
Cross sectional studies for prevalence
Cross sectional studies for cause
Example : Cross sectional studies for cause
 How to run a cross sectional study
 Formulate the research question (s) and choose the
sample population.
 Decide what variables of the study population are
relevant to the research question.
 A method for contacting sample subjects must be
devised and then implemented.
 In this way the data are collected and can then be
analyzed.
 Summary
Cross sectional studies look at each subject at one point in time
only.
 Subjects are selected without regard to the outcome of interest.
 Less expensive
 They are the best way to determine prevalence.
 Quick
 The principal summary statistic of cross sectional studies is the
odds ratio.
 Weaker evidence of causality than cohort studies.
 Inaccurate when studying rare conditions.
Q&A
Thank you