RETROSPECTIVE COHORT

GROUP # 3

Cohort Studies

Cohort

Group of people who have something in common when they are assembled Latin cohors warriors, the 10th part of a legion (3,000 6,000 men). Designated group of people who are followed or traced for a particular period of time

Research Study Design

Design
no DECISION: Alter the events under study? observational

Examples
- case series - cross-sectional - case-control - cohort - RCT - basic science

yes

experimental

Allocation of Exposures
Experimental Study Study group Random Allocation Group A Group B Observational Study Study group Nonrandom Allocation Group A Group B

Sampling in Cohort Studies

Probability (Random) Sample: - simple random sample: everyone in the actual population has an equal chance of being sampled. - stratified random sample: (age, gender, single stage, multistage) Non-Probability (Non-random) Sample: - Judgmental Sample: hand-picking participants - Grab (convenience) Sample: volunteers - Consecutive Sample: every patient that meets inclusion criteria. - Systematic Sample: every second person, etc. N.B. Probability Sample is required for hypothesis testing.

General Design of a Cohort Study

Defined Population
Target Pop:
Population at Risk

Study Sample

Representative Sample? Exposed NO Yes Not Exposed NO Yes Time Disease/Outcome Present?

Selection of Exposed Population

Depends on research question Depends on frequency of exposure

Common exposures: general population Rare exposures: selected groups Disease cannot be too rare

Outcome must not be rare in exposed

Attributable risk must be high

Accessible and compliant subjects

E.g., Nurses Health Study, British Physicians

Selection of Non-exposed Group

Similar as possible to exposed

Control for confounding factors Consider healthy worker effect

General Population?

Multiple groups

Time and Cohort Studies

Past
Cohort Assembled

Present
Follow-up Cohort Assembled

Future

= Historical (retrospective)
Follow-up

Prospective =

Mixed Cohort

Cohort Design
Prospective 2002 Study Sample Nonrandomized Exposed Disease 2010 No disease Not Exposed Disease No disease 2000 Historical 1990

Historical (Retrospective) Cohort Study

Identify cohort in the past

E.g., through records or administrative databases

Determine exposure or prognostic factors in the past

Again, records or databases Outcome can be identified in past or present Outcome must be after previous two steps

Identify outcome

Historical (Retrospective) Cohort Studies Strengths:

cohort easier to assemble (inception period in past) baseline measurements already available follow-up period already taken place less costly and time-consuming

Weaknesses:
no control over the quality of past measurements incomplete data sets control for confounding may be incomplete

Historical Cohort Example

Question: Are non-steroidal anti-inflammatory drugs a risk factor for kidney disease? Identify cohort e.g., people diagnosed with rheumatoid arthritis between January and December 1992 (provincial health database) Determine exposure status. Which of these patients were prescribed NSAIDs? Determine outcome. Did patient develop kidney disease during the five years after inception into cohort? (follow-up lasted until December 1997)

Evaluation of Mandibular Fractures in a Tertiary Military Hospital: A 10-year Retrospective Study

OBJECTIVE: The study aimed to evaluate mandibular fractures in a tertiary military hospital, to determine the age group in which injury occurred most often, to examine the various mechanisms injury, to determine the anatomical part of the mandible most frequently affected and to determine if there were significant relationships between the various mechanisms of injury and the different fracture sites.

Source: http://pso-hns.org/psojournals/pjohns/2011a/05-01-oa-03-mandibular-abstract.pdf

Misdiagnosis of the vegetative state: retrospective study in a rehabilitation unit

OBJECTIVE:

To identify the number of patients who were misdiagnosed as being in the vegetative state and their characteristics.

Source: http://www.bmj.com/content/313/7048/13.full

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