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Case Control Study

A case-control study compares individuals with a disease or health outcome (cases) to individuals without the disease or outcome (controls) to identify attributes associated with the outcome. Investigators ascertain exposure status after determining outcome status. Case-control studies are useful for rare diseases, when exposure data is difficult to obtain, and populations are dynamic. Proper selection of representative cases and controls is important to reduce bias and confounding. Sample size must be adequately powered to detect effects and reduce type II errors.

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Nirav Joshi
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© © All Rights Reserved
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Download as PPTX, PDF, TXT or read online on Scribd
89 views

Case Control Study

A case-control study compares individuals with a disease or health outcome (cases) to individuals without the disease or outcome (controls) to identify attributes associated with the outcome. Investigators ascertain exposure status after determining outcome status. Case-control studies are useful for rare diseases, when exposure data is difficult to obtain, and populations are dynamic. Proper selection of representative cases and controls is important to reduce bias and confounding. Sample size must be adequately powered to detect effects and reduce type II errors.

Uploaded by

Nirav Joshi
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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CASE-CONTROL STUDIES

Contents
Definition
Design of the study
When is case-control study warranted
Selection of Cases and Controls
Assuring adequate study power/Sample size
Bias
Confounding
Matching
Analysis
Advantages of the study
Disadvantages of the study
Nested Case Control Study
Case Cohort study
STROBE statement
References
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Definition

Case-control studies are the observational studies in


which person with a disease or health outcome
(cases) are compared with the individuals without the
disease or health outcome (controls) with regard to
various attributes

In such studies, investigator begins with the outcome


status of study participants (case or control) and then
ascertain their exposure status

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Design of Case-Control study

WERE WERE NOT WERE WERE NOT


EXPOSED EXPOSED EXPOSED EXPOSED

HAVE THE DISEASE DO NOT HAVE THE DISEASE

“Cases” ‘Controls”

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Design of Case-Control study(Contd.)

TIME
Direction of inquiry

Exposed
Cases
Not
exposed
Population

Exposed
Controls
Not
exposed
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Design of Case-Control study(Contd.)

Exposure Cases (disease present) Control (disease absent)


Present a b
Absent c d
Total a+c b+d

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When is a Case-Control Study
Warranted?
• Usually as a first step to study new diseases/diseases
of uncertain etiology, when many hypothesis are to be
tested

• Valuable when disease being investigated is rare

• Underlying population is dynamic

• Exposure data are difficult or expensive to obtain


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Selection of Cases

• Case definition- provide accurate classification of


those with and without disease

• Sources- clinical facilities, general population

• Selection of cases must be independent of their


exposure status

• Choose incident or prevalent cases?

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Selection of Controls

• The controls must be free from the


disease/outcome under study

• They must be as similar to the cases as possible


except for the disease

• Sources- hospital, neigbourhood, friends

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Selection of Controls(Contd.)

• Do the controls come from the same reference


population as the cases
• Are the controls similar to the case with regard to
their potential for past exposure
• Are the controls similar to the case with regard to
potentially confounding factors
• Have any restrictions or exclusion applied to cases
also been applied to controls
• Have the controls been selected from the same
time period as the cases

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Use of Multiple Controls
Same type
2, 3, or even 4 controls for each case (i.e., increasing
the ratio of matched controls to cases), increases the
power of the study
Different types
When there is concern that the controls may differ in
some way from what is “expected” in the general
population
Example

03/06/2023 Case-Control studies 11


Assuring adequate study power
The power of study is mainly related to the sample
size

So adequate sample size required to ensure high


degree of protection against type II error

Software programs are available for determining the


sample size with the desired level of power, given
certain study parameters (e.g.- Epi Info)

03/06/2023 Case-Control studies 12

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