Escolar Documentos
Profissional Documentos
Cultura Documentos
Studies
Studi Cross-sectional
Tujuan:
mempelajari angka kejadian suatu
penyakit/masalah kesehatan
mempelajari hubungan antara suatu faktor risiko
dengan angka kejadian suatu penyakit
time
Study only exists at this point in time
Cross-sectional Design
factor present
No Disease
factor absent
Study
population
factor present
Disease
factor absent
time
Study only exists at this point in time
Cross-Sectional Studies
or PREVALENCE
STUDY
AKA:SURVEY
Hallmark:
Risk factors (exposures) and disease
outcome are ascertained at a single
point in time in a cross-sectional
sample of subjects.
CROSS-SECTIONAL STUDIES
(PREVALENCE STUDIES)
9
PREVALENCE STUDY
METHODOLOGY-1
IT CAN BE DONE AT A SINGLE POINT OF
CALENDAR TIME (POINT PREVALENCE)
WHEN THE MEASUREMENT OF CAUSAL
RELATIONSHIP RELATE TO THE SAME
POINT IN STUDY MEMBERS LIVES
OR
CAN BE COMPLETED IN FEW MONTHS
OR YEARS (PERIOD PREVALENCE).
10
WHEN TO CONDUCT
PREVALENCE STUDIES?
11
PREVALENCE STUDY
METHODOLOGY-2
THE DESCRIPTIVE INFORMATION IS
OBTAINED BY MEANS OF DOOR TO
DOOR SURVEY.
DESKRIPTIF :
distribusi frekwensi kejadian penyakit/ masalah
kesehatan
berdasarkan orang - tempat - waktu
distribusi frekwensi variabel exposure dan
outcome
(angka prevalens)
Begin with
Defined Population
+
Exposure
(Risk Factor)
_
Contoh :
dalam suatu penelitian dengan disain potong lintang
.
D = bronchitis kronis (data kategorikal)
E = merokok (data kategorikal)
pengukuran D dan E dilakukan secara simultan
analisis analitik :
analisis khi kuadrat dengan tabel kontingensi
alpha ditentukan 0,05
untuk melihat hubungan E dan D hitung OR atau PR
Tabel kontingensi 2x2 untuk data diatas
Outcome
D+ D- total
sampel
E+ 40%
prevalensi terpapar dengan exposure = 40%
E- 60% prevalensi tidak terpapar dengan exposure = 60%
Distribusi frekwensi berdasarkan variabel outcome pada sampel
outcome positif D (disease) +
outcomenegatif D (disease)
D- 70%
Prevalensi disease = 30%
prevalensi not disease = 70%
Prevalence ratio of disease in exposed and unexposed
Disease
Yes No
Yes a b a
a+b
Exposure
PR =
c
No
c d c+d
200 D+ 100 D+
dari 400(E+) dari 600 (E-)
200 D - 500 D -
E+ 200 D+ 200 D -
E- 100 D+ 500 D -
OR = ---------------------------------------------------- = ------------ = 5
Odds D+ E - (kelompok tidaterpapar) = 100/500
Tabel kontingensi 2x2 untuk data diatas
Outcome
D+ D- total
Yes a b a
a+c
Exposure
PR =
b
No c d b+d
200 E+ 200 E+
dari 300 (D+) dari 700 (D-)
100 E - 500 E -
OR =
c
No c d c+d
c
1-
c+d
Formula of p / 1-p in exposed / p / 1-p in unexposed
Odds ratio of disease in exposed and unexposed
a a
a+b a+b
b
1- a a
a+b a+b b ad
OR = c = = =
c c bc
c+d
c c+d d
1-
c+d d
c+d
Odds ratio of exposure in diseased and not diseased
Disease
Yes No a
a+c
Yes a b a
1-
a+c
Exposure
OR =
b
No c d b+d
b
1-
b+d
Important characteristic of odds ratio
a a
a+c a+c
a c a
1-
a+c a+c c ad
ORexp = = = =
b b b bc
b+d b+d
b d
1-
b+d d
b+d
Grape 95 88 183
(52%)
8 35 43
Tomato
(19%)
Normal/
Low 50 450
Example:
Hypothesis:
Osteoarthritis
+ -
Obesity
+ 40 10 50
- 20 30 50
Cross-Sectional Study
63
Beware!
The fact that past exposure and health data are collected
does not make it a retrospective cohort study
If you start with people where they are now, some are
missing from the cohort that might have been defined
years ago
Bias You got the wrong answer
How did the people who are participating in your study get
to be where they are? Was it related to exposure? Was it
related to disease?
Populationbasedsample
Probabilitysample
Nonprobabilitysample
Useconsecutiveenrollmentifconveniencesample
Adjustforseasonalorothertimedependenttrends
MeasurementBiasinCross
SectionalStudies
Outcome
Misclassified(dead,misdiagnosed,undiagnosed)
Exposure
Differentialmisclassificationduetorecallbias
Timefromexposureimportantindicatorofaccuracy
Needetiologicallyrelevantexposure.Usecurrentexposure
if:
Exposureisfixedeg,bloodtype
Recentexposurecorrelateswellwithpriorexposure
Recallofpriorexposureunlikelytobereliableeg,diet
StrategiestoMinimize
MeasurementBias
Standardizemeasurementmethods
Trainandcertifyassessors
Refinetheinstruments
Calibratetheinstruments
Automatetheinstruments
Makeunobtrusivemeasures
Forkeyvariables,usedatafrom>1source
Blindingofsubjectandobserver
Implementationofthesestrategiesdependsonimportance
ofvariable,potentialeffectofinaccuracy,feasibilityand
cost.
Occupational Lead Neurotoxicity: a
behavioral and electrophysiological
evaluation
Selection bias?
Who choose (or are chosen for) dirty jobs?
Who stay there?
Who get dirtiest on the job?
Strengths:
May identify groups of persons at
high or low risk of disease