BASICS OF

EPIDEMIOLOGY &
BIOSTATISTICS
TOPIC; DESCRIPTIVE
EPIDEMIOLOGICAL
STUDIES.
Learning Tasks
•At the end of this session participants are expected to be able to:
1. Explain case report and case series study designs
2. Outline the advantages and disadvantages of case report and
case series studies
3. Explain ecological/correlation study design
4. Outline the advantages and disadvantages of ecological study
design
5. Explain cross section study design
6. Outline the advantages and disadvantages of cross section
study design
Case Report and Case Series Study Designs
(10 Minutes)
•Case reports and case series describe the
experience of a single patient or a group of patients
with a similar diagnosis. They represent the most
basic type of study design, in which researchers
describe the experience of a single patient (case
report), or a group of people (case series).
•They provide first clues in the
identification of new disease or adverse
effects of exposure, may lead to
formulation of new hypothesis. Unusual
cases may prompt further investigations
with rigorously study designs
Case report
oDescription in detail of the experience of a
single patient/an individual
oHas an unusual feature of disease, patient
exposure history or unusual medical event
or side effect of the drug
oCase series
•Case series
•Collection of individual case
reports, or a group of patients
with similar characteristics
•Describe some interesting or
intriguing observations
occurred in small number of
patients
•Advantages and Disadvantages of Case
Report and Case Series Studies (05
Minutes)
•Advantages
•Useful in formulating research
hypotheses and suggestive of risk factors
•Important step in recognizing new
diseases or risk factors.
 Disadvantages
oCase report based on one individual, so the
risk factor may occur by chance
oLack the denominator data (the population
from which the diseased subjects arose)
oNo comparison group
oDescribe highly selected individuals who may
not represent the general population
•Ecological Study Design (10 Minutes)
•Studies conducted in specific population groups (e.g.
Muslims, Catholics, Jews etc) having specific
characteristics in a specified geographical area. Causes
or risk factors are studied with regard to the diseases
and deaths occurred in a particular population. Both are
linked together and their co-occurrence (correlation) is
established in these studies for hypothesis formation.
•The variables include measurements taken
at the group level e.g. infant mortality
rates of different countries.
•The units of analysis are populations or
groups of people rather than individuals.
An example is the study of the
relationship. Conclusions of ecological
studies may not apply to individuals; thus
caution is needed to avoid the ecological
fallacy
•Ecological fallacy is an error
in inference that occurs when
association observed
between variables of a group
level, is assumed to exist at
an individual level
 Advantages and Disadvantages of Ecological Study
(05 Minutes)
 Advantages
o The study is conducted at group level, not at individual level,
hence relatively easy to do and quick also inexpensive
o Can be used as the first step in exploring the relationship
between an exposure and a disease
o It generates and support new hypotheses
o Ecological studies conducted over time on a specific
geographical area are more convenient to perform and form
hypotheses rather than studying whole.
•Disadvantages
• Ecologic bias/fallacy (Fail to reflect the
effect at the biological/individual level)
• Potential confounding factors cannot be
readily controlled
• The lack of adequate data
• Non-differential misclassification within
groups may lead to bias
• Usually rely on data collected for other
purpose
•Cross Section Study Design (10 Minutes)
•It is a study design that examines the relationship between diseases
(or other health-related characteristics) and other variables of interest
as they exist in a defined population at one particular time.
•It is so called because a cross section of a community (frequently
total population samples) is studied at a particular point or period of
time; and because both exposure and disease outcome are
determined simultaneously for each subject; it is as if we were
viewing a snapshot of the population at a certain point in time. Since
it is used in finding the prevalence of disease/events or conditions, it
is sometimes called prevalence study.
•It can be of descriptive nature when
studying the distribution of the
disease/event or condition and cannot
establish cause – effect relationship
•It can be analytical type when sought to
provide information about the presence
and strength of association (cause –
effect relationship), in this case the
exposure must precede the outcome
•It can be done at a single point of
calendar time (point prevalence)
•It can be completed in few months or
years (period prevalence)
•When the cross-sectional study is
repeatedly done, can show a serial trend
of disease/event or condition thus
serves the purpose of health and
disease surveillance of the population
• Advantages and Disadvantages of Cross
Sectional Study (05 Minutes)
• Advantages
• Comparatively cheap and quick
• Fairly simple to carry out and analyze
• Good for assessing prevalence and patterns of
disease occurrence
• Useful for health care planning
• Investigate trends over time (serial)
• Often provides early clues for hypothesis
generation
•Disadvantages
•They are not feasible for rare conditions
•Cannot establish temporal relationship
(i.e. whether the exposure or presence
of a characteristic preceded the
development of the disease or
condition).
•They provide no direct estimate of risk
or incidence
•They are prone to bias from
selective survival
•Not useful for conditions which
have a short duration (rare
exposures and outcomes)
•Weak in investigating causality
• Potential for bias (non
response)
Key Points (5 Minutes)
•Descriptive studies are concerned with and
designed only to describe the existing
distribution of variables without much
regard to causal relationships or other
hypotheses.
•Descriptive studies can be used to measure
trends in health indicators, generate
hypotheses, monitor public health policies,
etc.
Evaluation (5 Minutes)
•Differentiate between case
report and case series study
designs
•What is ecological fallacy?
•What are the disadvantages of
cross sectional study?
• References
• 
• Bonita, R., Beaglehole, R., & Kjellstrom, T. (2006). Basic epidemiology (2nd ed.). Geneva,
• Switzerland: WHO
• Campbell, D. T., & Stanley, J. C. (2015). Experimental and quasi-experimental designs for
research.
• Ravenio Books
• Field Epidemiology & Lab Training Program. (2008). Biostatistics workbook. Atlanta, GA:
• CDC.
• Gordis, L., 2014. Epidemiology Fifth., Philadelphia: Elsevier Inc.
• Greenberg, R. S., Daniels, S., Flanders, W., & Eley, J. (1993). Medical epidemiology. East
• Norwalk, CT: Appleton Lange
• Rothman, K.J., Greenland, S. & Lash, T.L., 2008. Modern Epidemiology, Philadelphia: Lippincott
Williams &
• Wilkins.
• Miquel Porta (2008). A Dictionary of Epidemiology. Oxford University Press, Inc.New York, New
York