Case control study

Rare Disease
[ risk:looking back from the disease] BK
 Basic Steps to conducting the Case
Control Study
1.Selection of Cases-

2.Selection of Control/Comparison group

3.Matching-

is a process of selecting control in such a way that they are similar to cases with
regard to certain pertinent selected variables, age, sex, race, socio economic
status etc which are known to influence the outcome of disease and which, if
not adequately matched for comparability, could distort or confound the result.

4.Measurement of exposure

5.Analysis and interpretation

 Case control study
 A case control study often called retrospective
studies.
 It has distinct features [MENU FB]
 Moves backward from effect to cause
 Employs a control or comparison group to
support or rebut an inference.
 Needs two population cases & controls.
 Unit is individual
 Focus is on a disease or some other health
problem that has already developed.
 Both exposure & outcome(Disease or Health
related state) have occurred before start of
study.
Basic steps of case control study
 Selection of case:
 Definition of case
 Diagnostic criteria

 Eligibility criteria: incident/not prevalent

 Sources of case
 Hospital
 General population
Selection of control:[process of taking into account/neutralizing
effect: Similar to cases except absence of disease

 Sources of control:
o Population based case control study
1. [general population that produced cases]
2. Nested case control study[nested in cohort]
o Hospital & community control
o Multiple control group
o Multiple control per case
Hospital control
Relatives
Neighbourhood
General population
 Matching:

• It is defined as process by which we select

controls in such a way that they are similar to
cases with regard to certain pertinent
selected variable e.g age ,sex,race etc
• which are known to influence the outcome of
disease &
• which if not adequately matched for
comparability could distort or confound the
result.
(i) Group matching -(frequency matching,
stratification)
(ii) Individual matching - (matched pairs)
 Measurement of exposure:

• Questionnaire
• Interviews
• Lab. Other instrumental investigations
• Studying past record e.g hospital records.
Analysis
To find out
Exposure rate among case & control to
suspected factor e.g rates among exposed &
unexposed
Estimation of disease risk associated with
exposure(odds ratio).
Odds ratio
A case control study on smoking as a risk factor of CHD
done at Bhutaha shows:
Now calculating the odds ratio
 Bias in case control study
 Confounding bias
 Recall bias
 Selection bias
 Berkesonian bias
 Interviewer bias
Advantages of case control study
 Easy
 Inexpensive
 Few subjects
 Suitable for rare disease
 No risk to subject
 Study of several different etiological factor
 Risk factor can be identified
 No follow up needed
 Minimal ethical problem
Disadvantages
• Problem of bias
• Difficulty in selecting control group
• Estimate relative risk only.
• Representativeness of cases & control may be
of concerned.
Example of case control study
 Case & control selected now measure the
exposure.
 Analyze the data
Cases(brain Control(no total
tumor) brain tumor)

Exposed(mobile) 20o(a) 9800(b) 10000

Not exposed 1oo(c) 9900(d) 10000

a+c=300 b+d=19700 G.T=20000

• Here we calculate rates
• & odds ratio /estimation of risk

Rate of (diseased)exposed: cases(exposed) /total exposed

=200/10000× 100
=2%
Now, (diseased)rate among unexposed:
=cases(unexposed)/total unexposed
=100/10000× 100
=1%
 Now calculate odds ratio(0D):
ODDS =a/a+c =a/c , b/b+d =b/d,
c/a+c d/b+d
 Now odds ratio =a/c =ad/bc
b/d
Where,ad=odds of exposed
+diseased&unexposed +no disease
bc=odds of exposed but no disease & not
exposed but have disease
 Now calculate odds ratio(0D):
ODDS =a/a+c =a/c , b/b+d =b/d,
c/a+c d/b+d
Here, a=200,b=9800,c=100,d=9900
Now odds ratio = 200 (a)
200+100 (a+c)
100 (c)
200+100(a+c)
9800 (b)
9800+9900(b+d)
9900 (d)
9800+9900(b+d)
• Now odds ratio
• =ad/bc
• =200 ×9900/100×9800
• Odds ratio=2.02
• Interpretation
• There is a 2.02-fold higher odds of mobile
user in brain tumor patients vs. non- brain
tumor patients.