RETROSPECTIVE COHORT
GROUP # 3
Cohort Studies
Cohort
Group of people who have something in common when they are assembled Latin cohors warriors, the 10th part of a legion (3,000 6,000 men). Designated group of people who are followed or traced for a particular period of time
Research Study Design
Design
no DECISION: Alter the events under study? observational
Examples
- case series - cross-sectional - case-control - cohort - RCT - basic science
yes
experimental
Allocation of Exposures
Experimental Study Study group Random Allocation Group A Group B Observational Study Study group Nonrandom Allocation Group A Group B
Sampling in Cohort Studies
Probability (Random) Sample: - simple random sample: everyone in the actual population has an equal chance of being sampled. - stratified random sample: (age, gender, single stage, multistage) Non-Probability (Non-random) Sample: - Judgmental Sample: hand-picking participants - Grab (convenience) Sample: volunteers - Consecutive Sample: every patient that meets inclusion criteria. - Systematic Sample: every second person, etc. N.B. Probability Sample is required for hypothesis testing.
General Design of a Cohort Study
Defined Population
Target Pop:
Population at Risk
Study Sample
Representative Sample? Exposed NO Yes Not Exposed NO Yes Time Disease/Outcome Present?
Selection of Exposed Population
Depends on research question Depends on frequency of exposure
Common exposures: general population Rare exposures: selected groups Disease cannot be too rare
Outcome must not be rare in exposed
Attributable risk must be high
Accessible and compliant subjects
E.g., Nurses Health Study, British Physicians
Selection of Non-exposed Group
Similar as possible to exposed
Control for confounding factors Consider healthy worker effect
General Population?
Multiple groups
Time and Cohort Studies
Past
Cohort Assembled
Present
Follow-up Cohort Assembled
Future
= Historical (retrospective)
Follow-up
Prospective =
Mixed Cohort
Cohort Design
Prospective 2002 Study Sample Nonrandomized Exposed Disease 2010 No disease Not Exposed Disease No disease 2000 Historical 1990
Historical (Retrospective) Cohort Study
Identify cohort in the past
E.g., through records or administrative databases
Determine exposure or prognostic factors in the past
Again, records or databases Outcome can be identified in past or present Outcome must be after previous two steps
Identify outcome
Historical (Retrospective) Cohort Studies Strengths:
cohort easier to assemble (inception period in past) baseline measurements already available follow-up period already taken place less costly and time-consuming
Weaknesses:
no control over the quality of past measurements incomplete data sets control for confounding may be incomplete
Historical Cohort Example
Question: Are non-steroidal anti-inflammatory drugs a risk factor for kidney disease? Identify cohort e.g., people diagnosed with rheumatoid arthritis between January and December 1992 (provincial health database) Determine exposure status. Which of these patients were prescribed NSAIDs? Determine outcome. Did patient develop kidney disease during the five years after inception into cohort? (follow-up lasted until December 1997)
Evaluation of Mandibular Fractures in a Tertiary Military Hospital: A 10-year Retrospective Study
OBJECTIVE: The study aimed to evaluate mandibular fractures in a tertiary military hospital, to determine the age group in which injury occurred most often, to examine the various mechanisms injury, to determine the anatomical part of the mandible most frequently affected and to determine if there were significant relationships between the various mechanisms of injury and the different fracture sites.
Source: [Link]
Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit
OBJECTIVE:
To identify the number of patients who were misdiagnosed as being in the vegetative state and their characteristics.
Source: [Link]
AS YOU SOW SO SHALL YOU REAP!!!
THANK YOU FOR YOUR KIND ATTENTION
