CASE-CONTROL STUDY

CASE-CONTROL STUDY

 Obseravational and analytical studies

 Longitudinal studies

 We start knowing the effect (the disease) and we look for the risk
factor/factors, in general, in a retrospective manner

 Case-control study types:

• prospective
• retrospective
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The design of the case-control study

exposed
Sample
with disease
unexposed

Target population

exposed
Sample
without disease
unexposed

Time
Study direction
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 Selecting disease cases: patients from a hospital or a medical service

 Selecting the control group:

• hospitalized patients suffering from another disease
• general population from the same town
• specific groups (family, friends)
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Sampling in case-control studies:

 Random sample (by chance)

 Systematic sample

 Stratified sample
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The data is organised into a 2x2 contingency table

With disease Without disease TOTAL

Exposed to the
risk factor a b a+b

Unexposed to
the risk factor c d c+d

TOTAL
a+c b+d a+b+c+d
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DATA ANALYSIS

 Exposure odds calculation for both case and control groups:

a
- exposure odds for cases =
c
b
- exposure odds for control group =
d
a
c  ad
 ODDS RATIO (OR) =
b bc
d
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INTERPRETATION

OR > 1 there is an association between exposure and disease

OR = 1
there is NO association between exposure and
disease
OR < 1
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STATISTICAL ANALYSIS FOR CASE-CONTROL STUDIES

• The appropriate statistical test is Chi² test

• If the obtained “p” value is smaller than 0,05 (p<0.05) then we

have a statistically significant result

• CI – must not contain the value 1 (lower limit should be greater

than 2)
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OR interpretation depending on CI:

 If OR>1 and CI limits are close to OR, but without including the
value 1, then we can state that there is a positive association
between the risk factor and the disease

 If OR>1 and CI includes the value 1 we can say that is NO

association between exposure and disease
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ADVANTAGES:
 Fast

 Cheap

 Easy to perform

 Requires a relatively small number of subjects

 It looks into more than one risk factor (more than one exposure)

 Suitable for rare diseases, with a high latency period

 They can determine causality, they are usefull for only one disease
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DISADVANTAGES:
 Memory errors, selection errors

 It doesn’t allow a direct calculation of incidence

 Data validation is difficult to determine

 Thay can’t be used for rare exposures

 They study only one effect

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EXAMPLE:
In an obstetrics clinic there was performed a study on the
newborns between 1960 and 2000, in order to establish a
possible connection between drinking alcohol during pregnancy
and the apparition of the lip and maxillary cleft. During this
study there were devised two groups, one of 43 newborns with
lip clefs or labio-maxillo-palatine clefs and a control group with
newborns without the malformation. There are no differences
between the two groups (except the presence of the
malformation in the cases group). There were excluded from the
sample lot the patients with other malformations besides lip
clefs or labio-maxillo-palatine clefs.