Case control

Monday, September 26, 2011

A Population

Monday, September 26, 2011

A Population

Monday, September 26, 2011

Monday, September 26, 2011

From the source population we select 17 individuals who were exposed to high levels of benzene.
Our study is designed to examine the effect of benzene exposure on the eventual development
of adult leukemia

Monday, September 26, 2011

Next we select a random sample of 83 workers who have no occupational exposure to benzene

Monday, September 26, 2011

 Follow-up lasts 20 years

No loss to follow-up!

Monday, September 26, 2011

Monday, September 26, 2011

20 Years Later

20 Years Later

After 20-years there are 6 cases in the

exposed
6 people x 10-years 6 cases / 280 person-years = 0.021
+
11 people x 20-years cases/person-year or 21 cases per 1,000
=280 person-years person years

Monday, September 26, 2011

20-years

Monday, September 26, 2011

After 20-years there are 5 cases

5x10 +
78 x 20 =
1,610 person-years
IR = 3.2 cases per 1,000 py

Monday, September 26, 2011

Measures of effect in cohort study

IRR = 21/3.2 = 6.57

Workers exposed to benzene were 6.57 times as likely to

develop leukemia after 20-years as workers who were not
exposed to benzene

IRD = 21-3.2 = 17.8 cases per 1,000 person years

There were an additional 17.8 cases per year for each 1,000
workers exposed to benzene.

Or, if we prevented the exposure in 1,000 people, 17.8 cases

would be avoided annually (assuming a causal relationship exists)

Attributable fraction in the exposed

17.8/21 = 0.852 = 85% of the cases in the exposed are due to

the exposure (assuming a causal relationship)

Or, (6.57-1)/6.57 = 85% attributed to exposure in the exposed

Monday, September 26, 2011

Case-Control study in the same population

Monday, September 26, 2011

Monday, September 26, 2011

Cases
Case Deni*on
Part of the deni*on is classic epidemiology
Person, Place, and Time
Also include diagnos*c tests, clinical and pathological
exams etc.
Use as much informa*on as is available

Source of cases
Hospitals, popula*on based, disease registry

Monday, September 26, 2011

Case selection

Now we choose incident cases

Define our cases
Workers in factories who develop

leukemia (or developed leukemia if

retrospective) over the 20-year period

Take a sample of cases (or enroll all cases

if possible)

Monday, September 26, 2011

Controls
A sample of the source popula*on that gave rise to
the cases
In a cohort study you are following this source
popula*on un*l they develop disease
In a case-control study, you sample this popula*on to
assess the exposure distribu*on in the popula*on

The would criterion

The source popula*on is a group whose members would
end up as a case in the study if they developed the
disease

Monday, September 26, 2011

Controls

Hospitalized controls

Must make sure that the condi*on for which they are in
the hospital has no rela*onship with the disease or
exposure of interest
The illness in the control group should have a similar
referral paIern to the disease you are studying

Popula*on Controls
More generalizable
Likely the same source popula*on that gave rise to cases
Time consuming, less interest to par*cipate, recall bias

Monday, September 26, 2011

Control selection

The most important criteria: if these non-cases would

have become diseased would we have identified them
as cases?

This ensures that the following goals for control

selection are met:

Controls come from the same source population

as cases

The exposure distribution in the controls should

match the exposure distribution of the entire
source population

Monday, September 26, 2011

 = case

Take random sample of non-cases. Well choose 22 to
have 2:1 ratio of controls to cases

Monday, September 26, 2011

Monday, September 26, 2011

6 exposed cases
5 unexposed cases

3 exposed non-cases
18 unexposed non-cases

Measure of effect in case-control

Odds ratio

Cases

Non-Cases

Exposed

Unexposed

18

OR = odds of exposure
among cases divided by odds
of exposure among controls
Can calculate this with the
cross product ratio:

(6*18)/(5*3)

7.2
Monday, September 26, 2011

Effect measures
Odds ratio? yes
Difference measures? no
Attributable fraction in exposed? yes
(7.2-1)/7.2=86%

Monday, September 26, 2011