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2.0case Control PPT F

Case control PPT

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Apurb Shrivastav
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310 views26 pages

2.0case Control PPT F

Case control PPT

Uploaded by

Apurb Shrivastav
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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CASE CONTROL

STUDY
- DR. APURB KUMAR (JR1)
- MODERATOR –
- DR. SHALINI SINGH
(ASSO. PROF)
- DR. SOMESH (SR)
Introduction
 Definition:
 A method of sampling a population in which:
• Cases (Disease) are identified and enrolled
• Controls (Non disease)
 Unit is the Individual.
 Subtype of analytical observational study
 Also called as - Retrospective study design

- TROHOC study etc..


Features
 Observational, Non Experimental.

 Explanatory (Analytical).

 Both exposure and outcome have occurred before the start of


the study.

 Proceeds backward from outcome(effect) to exposure (cause)


i.e Retrospective.

 It uses a control or a comparison group to support or refute an


inference.
What’s the need ?
 Disease Perspective  Researcher perspective
 The disease is rare  Limited resources in

 The disease has a long terms of material and


incubation and latent time.
 Investigating multiple
period.
 Data on exposure is risk factors.
small or expensive to
obtain.
 The study population is
dynamic.
 The risk factors for the
disease is not known.
Framework of case control study
(The 2X2 Table)
Basic steps
 Selection of cases and controls

 Matching

 Measurement of exposure

 Analysis and interpretation


Selection of cases and controls
 Selection of cases
• Definition of case
 Diagnostic criteria
 Eligibility criteria

• Sources of cases
 Hospitals
 General population
Definition of case
A. Definition of case:
 Diagnostic Criteria-

-Diagnostic criteria of disease and stage of the disease (e.g.,


breast cancer stage I must be included in the study must be
specified.
-Once the diagnostic criteria are established, they should not
be changed till the study is over.
 Eligibility Criteria
 -Only newly diagnosed (incident) cases within a specified
period of time are eligible.
 -Not old cases or cases in advanced stages of disease
(prevalent cases).
Sources of cases
a) Hospitals:
Cases may be drawn from a single hospital or a network of
hospitals, admitted during a specified period of time.
The entire case series or random sample of it is selected.

b)General population:
All cases of the study disease occurring within a defined
geographic area, during a specified period of time are
ascertained, often through a survey, a disease registry or
hospital network
The cases should be representative of all cases in community.
SELECTION OF CONTROLS
 Must be similar to the cases but free from the
disease.

 As a rule, comparison group identified before a


study is done.

 Difficultiesmay arise if the disease under


investigation occurs in subclinical forms.
1. HOSPITAL CONTROLS:
 Controls may be selected from same hospital as cases, but
with different illneses other than study disease.
 Hospital controls are often a source of “selection bias”.

2. RELATIVES:
 Sibling controls are unsuitable where genetic conditions are
under study.
3. NEIGHBOURHOOD CONTROLS:
 Controls may be drawn from persons living in same locality
as cases, persons working in the same factory or children
attending the same school.
4. GENERAL POPULATION:
 Population controls can be obtained from defined geographic
areas, by taking a random sample of individuals.
2. MATCHING
 Matching is defined as, the process by which we select

controls in such a way that they are similar to cases with

regard to certain pertinent selected variables(eg. Age) which

are known to influence the outcome of disease and which, if

not adequately matched for comparability, could distort or

confound the results.


 Examples to explain confounding.

 In the study of the role of alcohol in the aetiology of


oesophageal cancer, smoking is a confounding factor because

-It is associated with alcohol consumption.


-It is an independent risk factor for oesophageal cancer.

 Matching protects against an unexpected strong association


between the matching factor(eg. smoking) and the disease
(oesophageal cancer).
MEASUREMENT OF EXPOSURE
 Information about exposure should be obtained in precisely
the same manner both for cases and controls.

 Obtained by interviews, by questionnaires or by studying


past records of cases such as hospital records, employment
records, etc.
Bias
Bias is any systematic error in determination of association
between exposure and disease.

1. Bias due to confounding: This can be removed by matching.

2. Memory or recall bias: When cases and controls are asked


questions about their past history, it may be more likely for the
cases to recall the existence of certain events or factors, than the
controls.

3. Selection bias: The selection bias can be best controlled by


its prevention.
4.Berkesonian bias:
The bias arises because of the different rates of admission to
hospitals for people with different diseases.(i.e hospital cases and
controls).

5. Interviewers bias:
-Bias may also occur when the interviewer knows the hypothesis
and also knows who the cases are.

-The prior information may lead him to question the cases more
thoroughly than controls.
ANALYSIS
 The final step, to find out
a) Exposure rates among cases and controls to suspected factor.

b) Estimation of disease risk associated with exposure(Odds


ratio)
a) Exposure rates

 A. Cases = a/(a+c) = 33/35 = 94.2 per cent


 B. Controls = b/(b+d) = 55/82 = 67.0 per cent

P < 0.001
The above table shows that the frequency rate of
lung cancer was definitely higher among smokers,
then, among non-smokers.
b) Estimation of risk

The estimation of disease risk associated with exposure is obtained by an index


known as “Relative Risk”or “Risk ratio”
ODDS RATIO (CROSS-PRODUCT)
 Which is a measure of the strength of the association between
factor and outcome.

 The derivation of odds ratio is based on three assumptions:


-The disease being investigated must be relatively rare
-The cases must be representative of those with disease.
-The controls must be representative of those without the disease.
Using the previous Table data, the odds ratio would be
estimated as follows :-
Odds Ratio = (a/b) / (c/d) = ad/bc
= 33 X 27 / 55 X 2 = 8.1
In the above example , Smokers of less than 5 cigarettes
per day showed a risk of having Lung cancer 8.1 times that
of non- smokers.
Advantages and Disadvantages of Case Control
Study ADVANTAGES DISADVANTAGES
Relatively easy to carry out. Selection of an appropriate
control may be difficult
Rapid and inexpensive We cannot measure incidence,
(compared with cohort studies) and can only estimate the
relative risk
Require comparatively few Do not distinguish between
subjects. causes and associated factors
Particularly suitable to Problems of bias relies on
investigate rare diseases. memory or past records, the
(Leukamia in Adolescents) accuracy of which may be
uncertain.
No risk to subjects Not suited to the evaluation of
therapy or prophylaxis of
Allows the study of several
disease.
etiological factors ( e.g. Smoking)
Risk factors can be identified

No Attrition problems

Ethical problems are minimal


References
 ParkK. Park’s Textbook of Preventive Medicine.
27th edition.

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