OUR LADY OF FATIMA UNIVERSITY

FMCH II

COLLEGE OF MEDICINE BATCH 2017

EPIDEMIOLOGIC STUDIES/
OBSERVATIONAL STUDIES
Lectured by Dra. Garcia (013115)

gardens --fallacy-- secondhand smoking is the

cause)

STUDIES
1.DESCRIPTIVE
Descriptive studies

-does not look at individuals (not possible to link

exposure to occurrence of disease in the same
person)

-describes the occurrence of disease in diff

communities or in different subgroups
-provide information that can be used to test
etiologic hypothesis
-looks at situation as it is without trying to change
it
Types of Descriptive Studies:

ECOLOGIC /CORRELATION STUDIES

-uses data from entire population to compare

disease frequencies between:
a) different groups during the same period
of time
b) the same population at different points in
time
"unit of analysis is defined by group (defined
geographically on the basis of demographic
variables) and time"
Advantages:
-quick, easy, inexpensive
-use the available data or existing data
-acceptable for developing hypothesis
Limitations:

CASE REPORTS/ CASE SERIES

-most basic type of descriptive studies of

individuals
-a comprehensive documentation of a particular
patient/ case
-"comprehensive": detailed report starting from
the beginning following the progress up to the
outcome of the case
-a case may be documented this way because it is
a very rare condition or it may a very common
disorder but has presented differently or it has
progressed in a very unusual manner

CASE SERIES

-collection of a group of patients with the same

diagnosis or problems
-purpose: to come up with a common or modal
information such that in the end a conclusion of
what is common to all patients with the disorder
or the disease being studied can be made
Advantage:
-inexpensive and easy
-good for very rare occurrences

-ecologic fallacy (eg. Study that showed that lung

cancer is more common in men who are in beer

-lays the groundwork for future more powerful

studies

FMCH II: Epidemiologic (Observational) Studies Trans by MRPC 2015

Limitation:
-not a true epidemiologic study

CROSS SECTIONAL STUDIES

-an examination of the relationship between

diseases and other characteristics or variables of
interest as they exist in a define population at one
particular time
-prevalence of a disease (prevalence study or
survey)
-the investigator may have a problem in mind at
the start and from a population individuals with
the disease in question are identified
- the investigator then characterizes those with
the disease and those without
Subjects selected for the study --> subjects with
outcome or subjects with no outcome (time of
onset of injury)

2. Assessment of health needs, planning,

utilization, and evaluation of health
care services
3. For raising the question of the
presence of an association or
generation of etiological hypothesis
4. Determining the status of a disease or
condition
Advantages:
-inexpensive, relatively quick, and east, no followup is required
-good for populations that are difficult to access
-no one is exposed to the causal agent because of
the study or denied a potentially beneficial
therapy for you only observe
Limitations:
-susceptible to incidence (covers new cases; acute
cases); prevalence bias (new and old; chronic
diseases)
-you cannot evaluate the disease that is nor there
when you are present
-measures prevalence only
-can establish association but impossible to
determine causation
2. Analytic studies
ANALYTIC
STUDIES
-observational analytic studies

Uses of cross-sectional studies:

1. Community diagnosis
-more on the young or the old
-what diseases are prevalent
-what environmental conditions
Eg. Diarrhea, common cold
-to find out what is wrong in the community

-designed to test hypothesis and find out which

groups are affected and those who remained
healthy
Types of Analytic Studies:

CASE CONTROL STUDIES

-a comparison of people with disease (cases) and

people without disease (controls)
-showing that the suspected cause occurs more
frequently among those with the disease than
those without it

FMCH II: Epidemiologic (Observational) Studies Trans by MRPC 2015

-cases and controls are "matched" grouping which

is similar in all respect

-depends completely on high quality of existing

records

-study begins with the absence or presence of a

disease or outcome and a retrospective evaluation
is conducted to determine who was exposed and
who was not exposed

- particularly prone to bias especially selection

and recall (most difficult is choosing the control
and not the case because cases have standards)

Diagram:

-inefficient for evaluation if rare exposures unless

attributable risk percent is high

-green arrows indicates past cases (how many of

the cases have the risk factors or those without)

-temporal relationship between exposure and

outcome may be difficult to establish

-bigger rectangle in the cases (with disease)

indicates that the more cases have risk factors

-groups may be confounded (variable that may

not be noticed but can create a lot of changes in a
study)

-in the control, more cases predominantly have no

risk factors

Eg. Calcium supplementations in healing time of

px with fractures

COHORT STUDIES

-an observational study of a group of people with

a special characteristic/ risk factor/ exposure who
are followed over time to determine who develops
the outcome of interest
-compares people exposed to the suspected cause
and those not exposed showing that a greater
proportion of people develop the disease among
the exposed group than among the non-exposed
-no intervention is applied to the group
Advantages:

Types of Cohort:

-less expensive, less time period of study for you

only have to observe
-well studied to the evaluation if disease with ling
latent period or examining conditions that
develop over a long period of time
-optimal for evaluation of rare diseases

a) Concurrent Cohort
-study in the exposed and unexposed groups start
at the same time
-common exposures
b) Non- concurrent Cohort

-can examine multiple etiologic factors for a single

disease

-study on the exposed and unexposed groups does

not start at the same time

-ideal for investigating a preliminary hypothesis

(exploratory investigation)

-exposures that are not very common (eg.

Exposure to radiation)

Limitations:

FMCH II: Epidemiologic (Observational) Studies Trans by MRPC 2015

Diagram:

-large number of subjects required (it takes a long

time and your may lose some subjects; very small
number may not be enough to have conclusion)
-difficult to obtain control if therapy is popular or
most people have been exposed
-exposure may be associated with a confounder
-blindness among subjects and assessors may be
difficult to achieve (blinding: not knowing; single
blind: do not if they are exposed or not; double
blind: does not who are in the cohort or exposed
or not; triple blind: statistician do not know)

-start with the population then assign them based

on the risk factors

-for rare disorders large sample sizes or follow up

periods are necessary

-moving forward

EPIDEMIOLOGIC
MEASURES
EPIDEMIOLOGIC
MEASURES

-find out how many will have the outcome to those

who do not
-if there is associate of risk factor (exposure) with
the disease, higher disease incidence in those with
risk factors

RELATIVE RISK (RR)

-measure of association between risk factor and

outcome
-population based

Advantages:
-do not withhold treatment from subjects/ they
are not artificially subjected to potential hazards
-subjects could be matched for possible
confounders
-examine multiple effects of a single exposure

5% relative risk= 5 times more possible of getting

risk
-the higher RR is, the more incidence of getting
sick

ODDS RATIO (OR)

-minimizes bias in the ascertainment of exposure

-temporal sequence between exposure and
outcome can be more clearly established
-provides a strong evidence for possible cause and
effects-measures relative risk
-less costly than Randomized Control Trials
Limitations:
-expensive
-long follow up period needed

EXPERIMENTAL STUDIES
-designed to test such hypothesis by showing
whether or not he frequency if a disease may be
changes by altering exposure to a suspected cause
-changing the variable without merely observing

FMCH II: Epidemiologic (Observational) Studies Trans by MRPC 2015

Type of Experimental studies:

Clinical trials

-preventive clinical trial

-intervention clinical trial
-therapeutic clinical trial

Community trial

FMCH II: Epidemiologic (Observational) Studies Trans by MRPC 2015