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Case-Control Study: Dr. Sourab Kumar Das
Case-Control Study: Dr. Sourab Kumar Das
STUDY
DR. SOURAB KUMAR DAS
3 DISTINCT FEATURE OF CASE
CONTROL STUDY:
a) Both exposure and out come (disease) have occurred
before the start of the study.
b) The study proceeds backwards from effect to cause,
and
c) It uses a control or comparison group to support or
refute an inference.
Direction of inquiry
Start with :
Exposed CASES
(people with disease)
Non Exposed
POPULATIO
N
Exposed CONTROLS
(people without disease)
Non Exposed
BASIC STEP IN CASE-CONTROL STUDY
• SELECTION OF CASES
• SELECTION OF CONTROLS
• MATHCING
• MEASURMENT OF EXPOSURE
• ANALYSIS AND INTERPRETATION.
SELECTION OF CASES
1. HOSPITAL BASED
-all persons with the disease seen at a particular
medical care facility or group of facility
1.POPULATION OF AN ADMINISTRATIVE
AREA
• appropriate when the cases represent all, or the majority of, cases
occurring in the same area
• expensive, time consuming
• non-response is high
• concern on different information quality is raised, if the situations of the
interview are different.
2. HOSPITAL PATIENTS
• more practical
• patients with other diseases are subjected to the same selective
factors that influence the cases to come to the particular facility
• controls are ill persons, thus likely to be unrepresentative of the
population as a whole with respect to factors, e.g., smoking,
socioeconomic status
• should be of variety of conditions so that no
excessive representation in the control group
• note that the factors leading a patient to come to
a particular hospital are not the same for all
diseases
3. ASSOCIATES OF THE CASES
• attendance at the same school, similar type of employment, friends,
or residence in the same neighborhood
• these controls would be fairly similar matched to cases on
socioeconomic status and environmental exposures
• multiple call-backs are necessary, great efforts needed
• relatively expensive
• tendency to overmatched(cases and friends).
4. RELATIVES OF THE CASES
spouses or siblings since they are generally
similar in ethnic and social background to the
cases
not suitable choice if the study exposure is one
of which close relatives are likely to be similar,
e.g., diets, genetics background
EXAMPLES OF CASE-CONTROL STUDY
Exposed a b
Not Exposed c d
a/c ad
= b/d = bc
MATCHING
• THE PROCESS OF SELECTING CONTROLS SO THAT
THEY ARE SIMILAR TO THE CASES IN CERTAIN
CHARACTERISTICS, SUCH AS AGE, RACE, SEX,
SOCIOECONOMIC STATUS, AND OCCUPATION
• 2 TYPES: 1. GROUP MATCHING
2. INDIVIDUAL MATCHING
GROUP MATCHING
• ALSO KNOWN AS FREQUENCY MATCHING
• CONSISTS OF SELECTING THE CONTROLS IN SUCH
A MANNER THAT THE PROPORTION OF CONTROLS
WITH A CERTAIN CHARACTERISTIC IS IDENTICAL
TO THE PROPORTION OF CASES WITH THE SAME
CHARACTERISTIC
• EG. IF 25% CASES ARE MARRIED, CONTROLS ARE
SELECTED SO THAT 25% IS ALSO MARRIED
INDIVIDUAL MATCHING
• ALSO KNOWN AS MATCHED PAIRS
• HERE, FOR EACH CASE SELECTED FOR THE
STUDY, A CONTROL IS SELECTED WHO IS SIMILAR
TO THE CASE IN TERMS OF SPECIFIC VARIABLE
OR VARIABLES OF CONCERN
• EACH CASE IS INDIVIDUALLY MATCHED TO A
CONTROL
• OFTEN USED WHEN IT’S HOSPITAL CONTROLS
USE OF MULTIPLE
CONTROLS
• CONTROLS OF THE SAME TYPE
• IN CONDITIONS WHEN DISEASES RARE, OR CASES ARE
DIFFICULT TO OBTAIN
• INCREASES THE POWER OF THE STUDY (IF RATIO IS 1:4)
USE OF MULTIPLE
CONTROLS
• MULTIPLE CONTROLS OF DIFFERENT
TYPES
• TO GENERALISE THE RESULT TO GENERAL
POPULATION
• FOR EXAMPLE: USING THE HOSPITAL AND THE
NEIGHBORHOOD CONTROLS
• INVESTIGATOR WILL HAVE TO DECIDE WHICH
COMPARISON GROUP WILL BE USED AS “GOLD
STANDARD”
FACTORS TO KEEP IN MIND
WHEN MATCHING
ANALYSIS
• The final step is analysis, to find out
a)Exposure rates among case and controls to
suspected factor
b)Estimation of disease risk associated with
exposure(odds ratio).
EXAMPLE: A CASE CONTOL STUDY OF SMOKING
AND LUNG CANCER
• INEXPENSIVE
• RAPID
• NO RISK TO SUBJECTS
• ALLOWS STUDY OF SEVERAL DIFFERENT
ETIOLOGICAL FACTORS IN ONE STUDY
• SUITABLE FOR INVESTIGATION OF RARE DISEASES