COHORT STUDY
Dr Debadatta Chakrabarty
Epidemiology
Defined by John M. Last in 1988
“Study of Distribution and Determinants of
health related state or event in a specified
population and the application of this
study to the control of health problem”.
We measure –
Disease frequency
Diseases distribution
Determinants of disease.
TYPES OF EPIDEMIOLOGICAL STUDIES
1. OBSERVATIONAL STUDIES
A. DESCRIPTIVE STUDY
DESCRIBE DIESEASE BY
TIME
PLACE
PERSON
B. ANALYTICAL STUDIES
ECOLOGICAL STUDY
CROSS SECTIONAL STUDY
CASE-CONTROL STUDY
COHORT STUDY
2. EXPEREMENTAL STUDIES
RANDOMIZED CONTROLLED TRIAL (RCT)
FIELD TRIAL
COMMUNITY TRIAL
Descriptive Epidemiology
Describe the disease by
Time
Place
Person
•Cohort study is undertaken to support the
existence of association between suspected
cause and disease
A major limitation of cross-sectional surveys and
case-control studies is difficulty in determining if
exposure or risk factor preceded the disease or
outcome.
Cohort Study:
Key Point:
Presence or absence of risk factor is
determined before outcome occurs.
WHAT IS COHORT
Ancient Roman
military unit, A band
of warriors.
Persons banded
together.
Group of persons with
a common statistical
characteristic. [Latin]
E.g. age, birth date,
Cohort studies
longitudinal
Prospective studies
Forward looking study
Incidence study
starts with people free of disease
assesses exposure at “baseline”
assesses disease status at “follow-up”
INDICATION OF A COHORT STUDY
When there is good evidence of exposure
and disease.
When exposure is rare but incidence of
disease is higher among exposed
When follow-up is easy, cohort is stable
When ample funds are available
Frame work of Cohort studies
Disease Status
Total Yes No
Study
Exposure
Yes a+b a b cohort
Status
No Comparison
c+d c d cohort
N a+c b+d
General consideration while selection
of cohorts
Both the cohorts are free of the disease.
Both the groups should equally susceptible
to disease
Both the groups should be comparable
Diagnostic and eligibility criteria for the
disease should be defined well in advance.
Elements of cohort study
Selection of study subjects
Obtaining data on exposure
Selection of comparison group
Follow up
Analysis
Selection of study subjects
General population
Whole population in an area
A representative sample
Special group of population
Select group
occupation group / professional group (Dolls study )
Exposure groups
Person having exposure to some physical, chemical or
biological agent
e.g. X-ray exposure to radiologists
Obtaining data on exposure
Personal interviews / mailed questionnaire
Reviews of records
Dose of drug, radiation, type of surgery etc
Medical examination or special test
Blood pressure, serum cholesterol
Environmental survey
By obtaining the data of exposure we can
classify cohorts as
Exposed and non exposed and
By degree exposure we can sub classify cohorts
Selection of comparison group
Internal comparison
Only one cohort involved in study
Sub classified and internal comparison done
External comparison
More than one cohort in the study for the purpose of
comparison
e.g. Cohort of radiologist compared with
ophthalmologists
Comparison with general population rates
If no comparison group is available we can compare
the rates of study cohort with general population.
Cancer rate of uranium miners with cancer in general
population
Follow-up
To obtain data about outcome to be determined
(morbidity or death)
Mailed questionnaire, telephone calls, personal
interviews
Periodic medical examination
Reviewing records
Surveillance of death records
Follow up is the most critical part of the study
Some loss to follow up is inevitable due to death
change of address, migration, change of
occupation.
Loss to follow-up is one of the draw-back of the
cohort study.
ANALYSIS
Calculation of incidence rates among
exposed and non exposed groups
Estimation of risk
Incidence rates of outcome
Disease Status
Yes No Total
Study
Exposure
Yes a b a+b cohort
Status
No Comparison
c d c+d cohort
a+c b+d N
Incidence rate
Incidence among exposed =
a
a+b
Incidence among non-exposed =
c
c+d
Estimation of risk
Relative Risk
incidence of disease among exposed
RR = ______________________________
Incidence of disease among non-exposed
a/a+b
= _________
c/c+d
Estimation of Risk
Attributable Risk
Incidence of disease among exposed –
incidence of disease among non exposed
AR = _______________________________
Incidence of disease among exposed
a/a+b – c/c+d
AR = _______________
a/a+b
Smoking Lung cancer Total
YES NO
YES 70 6930 7000
NO 3 2997 3000
73 9927 10000
Find out RR and AR for above data
Incidence of lung cancer among smokers
70/7000 = 10 per 1000
Incidence of lung cancer among non-smokers
3/3000 = 1 per thousand
RR = 10 / 1 = 10
(lung cancer is 10 times more common among
smokers than non smokers)
AR = 10 – 1 / 10 X 100
= 90 %
(90% of the cases of lung cancer among
smokers are attributed to their habit of smoking)
Types of Cohort Study
Prospective cohort study
Retrospective (historical) cohort study
Combination of Retrospective and
Prospective cohort study.
Cohort studies
Strengths
Weaknesses
We can find out
incidence rate and losses to follow-up
risk often requires large
More than one sample
disease related to ineffective for rare
single exposure diseases
can establish cause - long time to complete
effect
good when exposure
expensive
is rare Ethical issues
minimizes selection
and information bias
THANK YOU
