1) The document describes sources for cases and controls in a case-control study. Cases can come from hospitals, general populations, or disease registries. Controls should be similar to cases except for the absence of disease and can come from hospitals, relatives, neighborhoods, or the general population.
2) Key factors in selecting controls include comparability, being at risk for the disease, and resembling cases except for disease status. Matching controls to cases on variables like age can improve comparability.
3) Exposure information should be collected the same way for both cases and controls. Analysis compares exposure rates between groups and estimates disease risk with odds ratios.
1) The document describes sources for cases and controls in a case-control study. Cases can come from hospitals, general populations, or disease registries. Controls should be similar to cases except for the absence of disease and can come from hospitals, relatives, neighborhoods, or the general population.
2) Key factors in selecting controls include comparability, being at risk for the disease, and resembling cases except for disease status. Matching controls to cases on variables like age can improve comparability.
3) Exposure information should be collected the same way for both cases and controls. Analysis compares exposure rates between groups and estimates disease risk with odds ratios.
1) The document describes sources for cases and controls in a case-control study. Cases can come from hospitals, general populations, or disease registries. Controls should be similar to cases except for the absence of disease and can come from hospitals, relatives, neighborhoods, or the general population.
2) Key factors in selecting controls include comparability, being at risk for the disease, and resembling cases except for disease status. Matching controls to cases on variables like age can improve comparability.
3) Exposure information should be collected the same way for both cases and controls. Analysis compares exposure rates between groups and estimates disease risk with odds ratios.
1) The document describes sources for cases and controls in a case-control study. Cases can come from hospitals, general populations, or disease registries. Controls should be similar to cases except for the absence of disease and can come from hospitals, relatives, neighborhoods, or the general population.
2) Key factors in selecting controls include comparability, being at risk for the disease, and resembling cases except for disease status. Matching controls to cases on variables like age can improve comparability.
3) Exposure information should be collected the same way for both cases and controls. Analysis compares exposure rates between groups and estimates disease risk with odds ratios.
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Sources of cases
The cases may be drown from
1. hospitals it is often convenient to select case from hospitals. Cases may be drawn from single hospital or network of hospitals, admitted during a specified period of time. The entire case series or random sample of it, is selected of study. Contd.. 2 General population. in a population based case control study. All cases of the study disease occurring within a defined geographic area during a specified period of time are ascertained often through a survey, disease registry or hospital network. Note: study case should be fairly representative of all cases in the community. Selection of controls The controls must be free of disease under study They must be similar of the cases as possible , except for the absence of the disease under study. Qualities needed in controls key concept: comparability is more important than representativeness in the selection of controls The control must be at the risk of getting the disease The control should resemble the case in all respects except for the absence of disease Sources of controls The possible sources from which controls may be selected include hospitals , relatives, neighbours and general population 1. Hospitals The controls may be selected from the same hospital as the cases , but with different illnesses other than the study disease. For example: if we are going to study cancer cervix patients, the control group may comprise patients with cancer breast, cancer of the digestive tract, or patient with non cancerous lesions and other patients 2 Relatives The control my also be take up from relatives ( spouses and siblings) sibling controls are unsuitable where genetic conditions are under study. 3 Neighborhoods controls The controls may be drawn from persons living in the 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 area, by taking a random sample of individuals free of the study disease. How many controls are needed? If many cases are available and large study is contemplated (considered) and the collect cases and control is about equal, then one tends to use one control for each case Contd.. In other words case to control ratio uses is usually 1:1; if large number and cost is the same for both groups If a study has a small number of cases, increasing the number of controls increases power of study. 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 (related , important ) selected variable (e,g age) which are known to influence the outcome of disease and which if not adequately matched for comparability, could distort or confound the results. There several kinds of matching procedures, one is group matching . This may be done by assigning cases to sub- categories (strata) Based on their characteristics e,g (age occupation social class) and then establishing appropriate controls. The frequency distribution of matched variable must be similar in study and comparison group. matching is also done by pairs, e,g for each case , a control is chosen which can be matched quite closely. E,g. if we have 50 years old mason with a particular disease, we will search for 50 year old mason without the disease. 3.Measurement of exposure Definition and criteria about exposure( or variables which may be of aetiological importance) are just as important as those used to define cases and controls . Information about exposure should be obtained in precisely the same manner both for cases and controls. This may be obtained bay interviews, by questionnaires or by studding past records of cases such as hospitals records 4.Analysis and interpretation The final step is analysis to find out a) Exposure rate among case and controls to suspected factor. b) Estimation of disease risk associated with exposure ( relative risk , Odds ratio) A. Exposure rates among cases and controls to suspect factor. A cases control study provides a direct estimation of the exposure rates (frequency of exposure) to a suspected factor in disease and non –disease group. Table (1) shows a cases control study of smoking and lung cancer. Cases (with lung cancer) Controls (with out lung cancer) Smokers (less than 5 cigarettes a 33(a) 55(b) day Non – smokers 2(c) 27(d) Total 35(a+c) 82(b+d)
Exposure rates: a) cases =a/(a+c)=33/35=94.2 percent
b) Controls =b/(b+d)= 55/82=67percent Table (1) shows that the frequency rate of lung cancer was definitely higher among smokers than non smokers Estimation of disease risk associated with exposure( odds ratio) The second analytical step is estimation of disease risk associated with exposure It should be noted table (1) that if the exposure rate was 94.2 % in the study group it does not mean 94.2% of those smoked would develop lung cancer. The estimation of disease risk associated with exposure is obtained by and index known “relative risk” RR or ‘RIKS RATIO” which is defined as the ratio between the incidence of disease among exposed persons and incidence among non exposed Contd.. A typical case control study does not provide incidence rates from which relative risk can be calculated directly In general the relative risk can be exactly determined only from cohort study. Its given by the formula Relative risk = incidence among exposed incidence among non exposed =a (a+b ____ c (c+d) Odd ratio From case control study we can drive what is known odds ratio (OR) this measure of the strength association b/w risk factor out come OR = ad bc =33x27/55x2=8.1 In the above example smokers less then 5 cigarettes per day showed a risk of having lung cancer 8.1 times that of non smokers. Advantages of case controls study Relatively easy to carry out Rapid, result can be obtained relatively quickly and inexpensive, ( compared with cohort study) Particularly suitable to investigate rare diseases. Allow the study of several different aetiological factors. Rational prevention and control programs can be established. No attrition (eating away, absent , missing. Problems), because controls studies do not require follow up of individuals into the future. Case control studies have been used effectively for studies of many cancers and other serious conditions. Disadvantages Problems of bias rely on memory (ability of individuals to record past events tends to be unreliable. Selection of an appropriate control group may be difficult We can not measure incidence Do not distinguish the time between outcome and associated factors because the data are collected after the event( retrospectively ) Another major concern is the representativeness of cases and controls.
