A cohort study or panel study is a form of longitudinal study (a type of observational study) used in medicine, social science, actuarial

science, and ecology. It is an analysis of risk factors and follows a group of people who do not have the disease, and uses correlations to determine the absolute risk of subject contraction. It is one type of clinical study design and should be compared with a crosssectional study. Cohort studies are largely about the life histories of segments of populations, and the individual people who constitute these segments.[1][2

A cohort is a group of people who share a common characteristic or experience within a defined period (e.g., are born, are exposed to a drug or vaccine or pollutant, or undergo a certain medical procedure). Thus a group of people who were born on a day or in a particular period, say 1948, form a birth cohort. The comparison group may be the general population from which the cohort is drawn, or it may be another cohort of persons thought to have had little or no exposure to the substance under investigation, but otherwise similar. Alternatively, subgroups within the cohort may be compared with each other.

Randomized controlled trials, or RCTs are a superior methodology in the hierarchy of evidence in therapy, because they limit the potential for any biases by randomly assigning one patient pool to an intervention and another patient pool to non-intervention (or placebo). This minimizes the chance that the incidence of confounding (particularly unknown confounding) variables will differ between the two groups. However, it is important to note that RCTs may not be suitable in all cases and other methodologies would be much more suitable to investigate the study's objective Cohort studies can either be conducted prospectively, or retrospectively from archived records

In medicine, a cohort study is often undertaken to obtain evidence to try to refute the existence of a suspected association between cause and effect; failure to refute a hypothesis strengthens confidence in it. Crucially, the cohort is identified before the appearance of the disease under investigation. The study groups follow a group of people who do not have the disease for a period of time and see who develops the disease (new incidence). The cohort cannot therefore be defined as a group of people who already have the disease. Prospective (longitudinal) cohort studies between exposure and disease strongly aid in studying causal associations, though distinguishing true causality usually requires further corroboration from further experimental trials.

The advantage of prospective cohort study data is that it can help determine risk factors for contracting a new disease because it is a longitudinal observation of the individual through time, and the collection of data at regular intervals, so recall error is reduced. However, cohort studies are expensive to conduct, are sensitive to attrition and take a long follow-up time to generate useful data. Nevertheless, the results that are obtained from long-term cohort studies are of substantially superior quality to retrospective/crosssectional studies, and cohort studies are considered the gold standard in observational epidemiology. Moreover, cohort studies are informative for efficiently studying a widerange of exposure-disease associations. Some cohort studies track groups of children from their birth, and record a wide range of information (exposures) about them. The value of a cohort study depends on the researchers' capacity to stay in touch with all members of the cohort. Some of these studies have continued for decades.

An example of an epidemiological question that can be answered by the use of a cohort study is: does exposure to X (say, smoking) associate with outcome Y (say, lung cancer)? Such a study would recruit a group of smokers and a group of non-smokers (the unexposed group) and follow them for a set period of time and note differences in the incidence of lung cancer between the groups at the end of this time. The groups are matched in terms of many other variables such as economic status and other health status so that the variable being assessed, the independent variable (in this case, smoking) can be isolated as the cause of the dependent variable (in this case, lung cancer).

In this example, a statistically significant increase in the incidence of lung cancer in the smoking group as compared to the nonsmoking group is evidence in favor of the hypothesis. However, rare outcomes, such as lung cancer, are generally not studied with the use of a cohort study, but are rather studied with the use of a case-control study.

Shorter term studies are commonly used in medical research as a form of clinical trial, or means to test a particular hypothesis of clinical importance. Such studies typically follow two groups of patients for a period of time and compare an endpoint or outcome measure between the two groups. Randomized controlled trials, or RCTs are a superior methodology in the hierarchy of evidence, because they limit the potential for bias by randomly assigning one patient pool to an intervention and another patient pool to non-intervention (or placebo). This minimizes the chance that the incidence of confounding variables will differ between the two groups.

Nevertheless, it is sometimes not practical or ethical to perform RCTs to answer a clinical question. To take our example, if we already had reasonable evidence that smoking causes lung cancer then persuading a pool of non-smokers to take up smoking in order to test this hypothesis would generally be considered quite unethical. Two examples of cohort studies that have been going on for more than 50 years are the Framingham Heart Study and the National Child Development Study (NCDS), the most widely-researched of the British birth cohort studies.

Key findings of NCDS and a detailed profile of the study appear in the International Journal of Epidemiology.[4] International Journal of Epidemiology[5] comparison of two Cohorts, Millennium Cohort Study (United States) and The Kings Cohort (United Kingdom) The largest cohort study in women is the Nurses' Health Study. Started in 1976, it is tracking over 120,000 nurses and has been analyzed for many different conditions and outcomes. The largest cohort study in Africa is the Birth to Twenty Study which began in 1990 and tracks a cohort of over 3,000 children born in the weeks following Nelson Mandela's release from prison. Other famous examples are the Grant Study tracking a number of Harvard graduates from ca. 1950.77, and the Whitehall Study tracking 10,308 British civil servants.

The diagram indicates the starting point and direction of cohort and case-control studies. In Case-control studies the analysis proceeds from documented disease and investigations are made to arrive at the possible causes of the disease. In cohort studies the assessments starts with the putative cause of disease, and observations are made of the occurrence of disease relative to the hypothesized causal agent.[6]

A "prospective cohort" defines the groups before the study is done, while historical studies, which are sometimes referred to as "retrospective cohort", defines the grouping after the data is collected. Examples of a retrospective cohort are Long-Term Mortality after Gastric Bypass Surgery.[7] and The Lothian Birth Cohort Studies.[8] Though historical studies are sometimes referred to as retrospective study, it a misnomer as the methodological principles of historical cohort studies and prospective studies are the same.[6]

Main article: Nested case-control study An example of a nested case-control study is Inflammatory markers and the risk of coronary heart disease in men and women, which was a case control analyses extracted from the Framingham Heart Study cohort.[

Household panel survey Household panel surveys are an important sub-type of cohort study. These draw representative samples of households and survey them, following all individuals through time on a usually annual basis.

A longitudinal study is a correlational research study that involves repeated observations of the same variables over long periods of time often many decades. It is a type of observational study. Longitudinal studies are often used in psychology to study developmental trends across the life span, and in sociology to study life events throughout lifetimes or generations.

The reason for this is that unlike cross-sectional studies, longitudinal studies track the same people, and therefore the differences observed in those people are less likely to be the result of cultural differences across generations. Because of this benefit, longitudinal studies make observing changes more accurate and they are applied in various other fields. In medicine, the design is used to uncover predictors of certain diseases. In advertising, the design is used to identify the changes that advertising has produced in the attitudes and behaviors of those within the target audience who have seen the advertising campaign.

Because most longitudinal studies are observational, in the sense that they observe the state of the world without manipulating it, it has been argued that they may have less power to detect causal relationships than do experiments. But because of the repeated observation at the individual level, they have more power than crosssectional observational studies, by virtue of being able to exclude time-invariant unobserved individual differences, and by virtue of observing the temporal order of events.

Longitudinal studies allow social scientists to distinguish short from long-term phenomena, such as poverty. If the poverty rate is 10% at a point in time, this may mean that 10% of the population are always poor, or that the whole population experiences poverty for 10% of the time. It is not possible to conclude which of these possibilities is the case using one-off crosssectional studies.

Types of longitudinal studies include cohort studies and panel studies. Cohort studies sample a cohort, defined as a group experiencing some event (typically birth) in a selected time period, and studying them at intervals through time. Panel studies sample a cross-section, and survey it at (usually regular) intervals. A retrospective study is a longitudinal study that looks back in time. For instance a researcher may look up the medical records of previous years to look for a trend.

Cross-sectional studies (also known as Crosssectional analysis) form a class of research methods that involve observation of all of a population, or a representative subset, at one specific point in time. They differ from case-control studies in that they aim to provide data on the entire population under study, whereas case-control studies typically include only individuals with a specific characteristic, with a sample, often a tiny minority, of the rest of the population.

Cross-sectional studies are descriptive studies (neither observational nor experimental). Unlike case-control studies, they can be used to describe absolute risks and not only relative risks.[citation needed] They may be used to describe some feature of the population, such as prevalence of an illness, or they may support inferences of cause and effect. Longitudinal studies differ from both in making a series of observations more than once on members of the study population over a period of time.

Cross-Sectional Studies in Medicine Cross-sectional studies involve data collected at a defined time. They are often used to assess the prevalence of acute or chronic conditions, or to answer questions about the causes of disease or the results of medical intervention. They may also be described as censuses. Cross-sectional studies may involve special data collection, including questions about the past, but they often rely on data originally collected for other purposes. It is moderately expensive, not suitable for rare diseases. Difficulty in recalling past events may also contribute bias.

Use of routine data: large scale, low cost to the researcher The use of routinely collected data allows large cross-sectional studies to be made at little or no expense. This is a major advantage over other forms of epidemiological study. A natural progression has been suggested from cheap cross-sectional studies of routinely collected data which suggest hypotheses, to case-control studies testing them more specifically, then to cohort studies and trials which cost much more and take much longer, but may give stronger evidence. In a cross-sectional survey, a specific group is looked at to see if an activity, say alcohol consumption, is related to the health effect being investigated, say cirrhosis of the liver. If alcohol use is correlated with cirrhosis of the liver, this would support the hypothesis that alcohol use may cause cirrhosis.

Routine data not designed to answer the specific question However, routinely collected data does not normally describe which variable is the cause and which the effect. Cross-sectional studies using data originally collected for other purposes are often unable to include data on confounding factors, other variables that affect the relationship between the putative cause and effect. For example, data only on present alcohol consumption and cirrhosis would not allow the role of past alcohol consumption, or of other causes, to be explored. Most case-control studies collect specifically designed data on all participants, including data fields designed to allow the hypothesis of interest to be tested. However, in issues where strong personal feelings may be involved, specific questions may be a source of bias. For example, past alcohol consumption may be incorrectly reported by an individual wishing to reduce their personal feelings of guilt. Such bias may be less in routinely collected statistics, or effectively eliminated if the observations are made by third parties, for example taxation records of alcohol by area.

Aggregated data and the "ecological fallacy" Cross-sectional studies can contain individual-level data (one record per individual, for example, in national health surveys). However, in modern epidemiology it may be impossible to survey the entire population of interest, so cross-sectional studies often involve secondary analysis of data collected for another purpose. In many such cases, no individual records are available to the researcher, and group-level information must be used. Major sources of such data are often large institutions like the Census Bureau or the Centers for Disease Control in the United States. Recent census data is not provided on individuals - in the UK individual census data is released only after a century. Instead data are aggregated, usually by administrative area. Inferences about individuals based on aggregate data are weakened by the ecological fallacy. Also consider the potential for committing the "atomistic fallacy" where assumptions about aggregated counts are made based on the aggregation of individual level data (such as averaging census tracts to calculate a county average). For example, it might be true that there is no correlation between infant mortality and family income at the city level, while still being true that there is a strong relationship between infant mortality and family income at the individual level. All aggregate statistics are subject to compositional effects, so that what matters is not only the individual-level relationship between income and infant mortality, but also the proportions of low, middle, and high income individuals in each city. Because case-control studies are usually based on individual-level data, they do not have this problem.

A randomized controlled trial (RCT) is a type of scientific experiment - a form of clinical trial - most commonly used in testing the safety (or more specifically, information about adverse drug reactions and adverse effects of other treatments) and efficacy or effectiveness of healthcare services (such as medicine or nursing) or health technologies (such as pharmaceuticals, medical devices or surgery).

The key distinguishing feature of the usual RCT is that study subjects, after assessment of eligibility and recruitment, but before the intervention to be studied begins, are randomly allocated to receive one or other of the alternative treatments under study. Random allocation in real trials is complex, but conceptually, the process is like tossing a coin.

After randomization, the two (or more) groups of subjects are followed up in exactly the same way, and the only differences between the care they receive, for example, in terms of procedures, tests, outpatient visits, follow-up calls etc. should be those intrinsic to the treatments being compared. The most important advantage of proper randomization is that it minimises allocation bias, balancing both known and unknown prognostic factors, in the assignment of treatments."[2

The terms "RCT" and randomized trial are often used synonymously, but some authors distinguish between "RCTs" which compare treatment groups with control groups not receiving treatment (as in a placebocontrolled study), and "randomized trials" which can compare multiple treatment groups with each other.[3] RCTs are sometimes known as randomized control trials.[4] RCTs are also called randomized clinical trials or randomized controlled clinical trials when they concern clinical research;[5][6][7] however, RCTs are also employed in other research areas such as criminology, education, social work and international development.