Cohort studies

Dr. Kashif Shafique

MBBS (Dow),MPH (Glasgow), PhD (Glasgow)

Professor & Principal

School of Public Health
Director – Office of Research, Innovation and
Commercialization
Head – Department of Research
Dow University of Health Sciences.
 0BJECTIVE

• To understand the design of cohort studies

•Estimation of risks in cohort studies

•Advantages and disadvantages

•Variants of Cohort and Case-Control Studies

 Time and Study Designs

Past Present Future

Cross-sectional:
Classify exposure
and disease at one time

Classify by
Case-control:
Classify by
exposure
disease

Cohort: Classify by
Classify by disease
exposure
Cohort Studies

 A cohort study is one that follows a defined group (cohort)

over a given period. The usual approach is to start with healthy
or unaffected subjects.
 Group by common characteristics
 Start with a group of subjects who lack a positive history of
the outcome of interest yet are at risk for it (cohort).
 Think of going from cause to effect.

 The exposure of interest is determined for each member of the

cohort and the group is followed to document incidence in the
exposed and non-exposed members.
 disease
Factor
Study present no disease
population
free of
disease
Cohort Design

disease Factor
absent
no disease
present
future

time
Study begins here
 Types of Cohort Studies

 Prospective (concurrent)
 Retrospective (historical)
 Types of Cohort Studies

 Prospective – cohort characterized by determination of

exposure levels (exposed vs. not exposed) at baseline (present)
and followed for occurrence of disease in future
 Groups move through time as they get older

 Retrospective - makes use of historical data to determine

exposure level at some baseline in the past and then
determine subsequent disease status in the present.
Prospective Studies

 Also called
 longitudinal

 concurrent

 incidence studies

 Looking into the future

 Example:
 Framingham Study of coronary heart disease (CHD)
2022

2022

This type of study design is called a prospective cohort study

 2021

This type of study design is called a retrospective cohort

or historical cohort study
 Retrospective Cohort study

Exposed Outcome

Measure exposure
and confounder
variables

Baseline Non-exposed Outcome

time
Study begins here
 Framingham Study

 Designed to study the effect of multiple factors on coronary

heart disease (CHD):
 age

 hypertension

 elevated blood cholesterol

 tobacco smoking

 increased physical activity

 increase in body weight

 diabetes mellitus
 Framingham Study Design

 Framingham, Massachusetts population was 28,000

 Study design called for a random sample of 6,500
 Enrollment questionnaire form targeted age range 30-59
years
 No clinical evidence of atherosclerotic cardiovascular
disease
 Cohort re-examined every two years
 Problems? white, middle class
Data Gathering

 Person - to - person
 Drop off questionnaire
 Mailed to people
 Telephone interview
Potential Biases in Cohort Studies

 Information bias
 Bias in estimation of the outcome
 Bias from non-response
 Bias from losses to follow-up
Advantages of Prospective Cohort Studies

 Considered as gold standard in observational epidemiology

 Large sample sizes (still an advantage, larger the sample more
likely to be representative)
 Temporal relationship can be ascertained
 Can be used to prove cause-effect
 Assess magnitude of risk
 Number and proportion of cases that can be prevented
Advantages of Prospective Studies (cont’d)

 Completeness and accuracy

 Quality of data is high
 Considers seasonal and other variations over a long period
 Tracks effects of aging process
Disadvantages of Prospective Cohort Studies

 Large study populations required

 not easy to find subjects

 Expensive
 Unpredictable variables
 Results not extrapolated to general population
 Study results are limited
 In some cases time consuming/results are delayed