Cohort study

OBSERVATIONAL
STUDY

Individual Group
participants participants

Non-comparative Comparative
study study Ecological study
Descriptive Analytical

Case series Case study

 Comparative
study

Exposure and Groups defined

outcome Groups defined by exposure
measured by outcome
at the same time

Cross-sectional Case-control Cohort study

study study
 Cohort study

• Cohort was the roman

term for group of
soldiers that marched
together .
• In clinical research a
cohort is a group of
subject followed over
time.
 Cohort study

Aims to investigate whether

exposure of subjects to a certain
aetiological factor will affect
the incidence of a disease in the
future.
Cohort study
 Cohort study design properties

The subjects (cohort)

chosen for the study
should represent the
population
 Cohort study design properties

For ease of data collection, the

cohorts are usually
chosen from a similar source:
• Same university,
• Alive in the same area.
 Cohort study design properties

The cohorts are disease-free at

the start of the study.
 Cohort study design properties

The exposures of interest are

then measured at base line in
these subjects
 Cohort study design properties

The subjects are followed up

over time (exposed and non-
exposed)
 Cohort study design properties

Allow enough time for a

sufficient number of subjects to
develop the disease of interest.
 Cohort study design properties

Maintain a regular contact

with subjects to minimize
dropout rates.
Prospective Cohort study

Compare
 Why the control?

100 patients with liver

cirrhosis all of them
are alcohol drinker

Is this study prove that alcohol

lead to liver cirrhosis ?
 Why the control?

So appear phenomenon in
single group regardless of high
prevalence, we can not put a
relation until we look for other
group without exposure .
 Prospective Cohort study
2018 Design (2 groups) 2023
Already drinking Liver cirrhosis

Exposed No Liver cirrhosis

Compare
Already not
drinking Liver cirrhosis
Non exposed
No Liver cirrhosis
 Prospective Cohort study

We divided the patients

according Risk factor
(Exposure)
 Prospective Cohort study

Design (2 groups) The researcher

 One group or 2 groups

 know the outcome No

Exposed

 Go forward

Non exposed Backward

 Advantages Prospective Cohort study

The strongest
observational study
to get evidence
Advantages Prospective Cohort study

Establish
Causality
Advantages Prospective Cohort study
Outcomes
Allow studying
multiple
outcomes for 1
exposure
 Advantages Prospective Cohort study

Measure Risk Ratio

(Relative Risk) (RR)
 Risk Ratio (Relative Risk) (RR)
The risk of developing the disease
in the population can
be compared between the exposed
and unexposed
groups by calculating the risk ratio
(also referred to as
the relative risk).
Risk Ratio (Relative Risk) (RR)

Exposure
Total
  Yes No Incidence
Yes d1 d0 d1+d0 d1/d1+d0
Disease
No h1 h0 h1+h0 h1/h1+h0

Total n=d1+d0+
  d1+h1 d0+ho h1+h0  
d = disease h = healthy 1 = exposed 0 = unexposed
 Interpretation of Relative risk (RR)
The risk ratio indicates the increased (or decreased) risk of disease
associated with the exposure of interest.

If the risk ratio is 1, the risk of disease is the same in

the exposed and unexposed groups.

If the risk ratio is 2, the exposure of interest doubles

the risk of disease.
 Interpretation of Relative risk (RR)

If the risk ratio is 0.5, the exposure of interest halves

the risk of disease.

If the risk ratio is 0.25, the exposure of interest

reduces the risk of disease by 75%
 Example

Lung cancer
Total Smoking
NO Yes

100 40 60 Yes
100 90 10 No
200 130 70 Total
Disadvantages Prospective Cohort study

Not suitable for rare

diseases:-
• Length of follow-up
• Very large sample
sizes are required
Disadvantages Prospective Cohort study

Follow-up
(Dropouts)

1500 900
 Disadvantages Prospective Cohort study

Expensive