Cohort Study

Associate Professor  Dr. Wongsa Laohasiriwong

Faculty of Public Health, Khon Kaen University
May17, 2017
 Definition of Cohort Study

Cohort:
a :  one of 10 divisions of an ancient Roman legion
b :  a group of warriors or soldiers
c :  band, group
d :  a group of individuals having a statistical factor (as age or class membership) in common in a
demographic study.
Concept of Cohort
 Group of individuals,
all similar in some
trait, and move
forward together as a
unit

https://www.uab.edu/medicine/obgynresidency/images/PDF
s/JC_Cohort_studies.pdf
 Type of Cohort
• Birth cohort Birth cohort : all born in the same : all
born in the same period (usually a year) in a defined area
• Inception cohort: Assembled at a : Assembled at a
given point based on some factor, e.g. where they live or
work where they live or work
• Exposure cohort: Assembled as a group based on a
common exposure group based on a common exposure
– radiation exposure during testing
– asbestos exposure in the industry

https://www.uab.edu/medicine/obgynresidenc
y/images/PDFs/JC_Cohort_studies.pdf
 Type of Cohort
• Fixed Cohort :
all born in the : all born in the same period
(usually a year ) in a defined area
• Dynamic or open cohort :
Assembled at a given point based on
some factor, e.g. where they live or work
where they live or work
Design of a Cohort Study

Sukon Kanchanaraksa. 2008

Johns Hopkins University
 Types of Cohort Studies
 Prospective cohort study
− Concurrent cohort study or longitudinal study

 Retrospective cohort study

− Non-concurrent cohort or historical cohort study

• Ambispective cohort study

 Prospective cohort study
Investigator
• Starts the study (from the beginning) with the identification of the population
and the exposure status (exposed/not exposed groups)
• Follows them (over time) for the development of disease
• Takes a relatively long time to complete the study (as long as the length of the
study)

Prospective cohort studies are conducted by making all observations

on exposure and disease status after the onset of the investigation.
Prospective Cohort Study

Cian O'Brien. 2014

http://prehospitalresearch.eu/?p=2706
 Framingham study
• Have began since1948:
n=5,209
(5,123 spouses and children added in 1971)
• Selected not based on exposures, but on stable
pop.,
• wide spectrum of occupations, single hospital,
annual updated population lists •
• Outcomes: Incidence rates an d other descriptive
measures
Prospective versus Retrospective Studies ,School
of Public Health - Boston University
 Retrospective cohort study
Investigator
• Uses existing data collected in the past to identify the population and the
exposure status (exposed/not exposed groups)
• Determines at present the (development) status of disease
Investigator spends a relatively short time to:
• Assemble study population (and the exposed/not exposed groups) from past
data
• Determine disease status at the present time (no future follow-up)

Retrospective cohort studies involve observations on exposure and

disease status prior to the onset of the study
Retrospective Cohort Study

Cian O'Brien. 2014

http://prehospitalresearch.eu/?p=2706
 Combined Prospective and
Retrospective Cohort Study
Investigator uses existing data collected in the past to:
• Identify the population and the exposure status (exposed/not
exposed groups)
• Follow them into the future for the development of the disease
Investigator
• Spends a relatively short time to assemble study population (and the
exposed/not exposed groups) from past data
• Will spend additional time following them into the future for the
development of disease
 Wayne W. LaMorte.2016 , Boston University School of public health.
http://sphweb.bumc.bu.edu/otlt/mph-modules/ep/ep713_cohortstudies/ep713_cohortstudies_print.html
Comparing Cohort study
 Cohort Studies for Incidence
• Is always related either explicitly or by implication
to a time period with regard to disease (problem) it
can be defined as the number of new cases that
develop during a specified time interval.
Calculate and compare

Sukon Kanchanaraksa. 2008ม Johns Hopkins University

 Example : Cohort Studies for cause
Table 1. Calculation of the rate ratio from a hypothetical cohort study of smoking and
cancer of the pancreas followed for 1 year.
 Example Table and Results
Title : Antenatal Betamethasone for Women
at Risk for Late Preterm Delivery

Results
Two women in each study group
were lost to follow-up, so outcome
information was available for 2827
neonates. There were no stillbirths
or neonatal deaths within 72 hours.
The rate of the primary outcome was
lower in the betamethasone group
than in the placebo group (11.6% vs.
14.4%; relative risk, 0.80; 95%
confidence interval [CI], 0.66 to
0.97; P=0.02)
Cynthia Gyamfi-Bannerman. 2016.
N Engl J Med 2016; 374:1311-1320April 7, 2016
 Bias in Cohort Studies
Selection bias
- Select participants into exposed and not exposed groups based on
some characteristics that may affect the outcome.
Information bias
- Collect different quality and extent of information from exposed and
not exposed groups.
- Loss to follow-up differs between exposed and not exposed
(or between disease and no disease)
Misclassification bias
- Misclassify exposure status or disease status.
 Advantages and Disadvantages
of Prospective Cohort Study
Advantages:
- Can evaluate multiple effects of a single exposure.
- More efficient for rare exposures and outcomes with long
induction and latency periods.
- Can directly measure incidence.
- Clear chronological relationship between exposure and
outcome.
 Advantages and Disadvantages
of Prospective Cohort Study
Disadvantages:  
-Expensive
-Time-consuming
- Inefficient for rare outcomes with long induction or latency periods
- Losses to follow-up can affect validity of results
- Often requires a large sample size
- Changes over time in diagnostic methods may lead to biased results
Q&A
Thank you