Cohort Study

Cohort Study..
Design, Steps, Analysis
Dr. Ankush Jagota

Research studies
02/01/2024 Dr. Nilesh G. Patel 2

Design of Cohort study
Exposure No Disease
(People with Exposure)
Population Disease
Disease
Comparison gp
(People without Exposure)
No Disease
Direction of inquiry
Time- Forward
Concept of cohort
• The cohort is defined as a group of people
who share a common characteristic or
experience within a defined time period.
- Marriage cohort,
- Birth cohort,
- Exposure cohort
- Occupation cohort…..
Comparison Group
• It may be general population from which the
cohort is drawn,
or
• It may be another cohort of persons thought
to have had little or no exposure to the
substance in question but otherwise similar
Indication for cohort study
• When there is good evidence of an association

between exposure and disease after
descriptive & case-control study.
• When exposure is rare, but the incidence of
disease is high among exposed
• When ample funds are available.
Pre-requisite
• Cohort must be free from the disease under

study
• Both group should equally susceptible to the
disease under study.
• Both group should be comparable
• Diagnostic & eligibility criteria of the disease
must be defined before hand.
Basic steps
1. Selection of study objects
2. Obtaining data on exposure.
3. Selection of comparison group.
4. Follow up.
5. Analysis
1. Selection of study objects
• General population: When the exposure or cause of

death is fairly frequent in the population, cohorts may be
assembled from the general population, residing in well-
defined geographical, political and administrative areas
• Special groups:
– Selected groups : These may be professional groups
(e.g., doctors, nurses, lawyers, teachers, civil servants)
– Exposure groups : If the exposure is rare, A readily
accessible source of these groups is workers in
industries and those employed in high-risk situations
(e.g., radiologists exposed to X-rays).
2. Obtaining data on exposure
Information about exposure may be obtained directly
from
• Cohort members – through interview of personal
questionnaires
• Review of records – certain surgery, dose of radiation
etc
• Medical examination / test – blood pressure or
cholesterol
• Environmental surveys – exposure level of suspected
factor in environment
Information on Exposure
Classification
• according to whether or not they have been
exposed to the suspected factor, and
• according to the level or degree of exposure,
at least in broad classes, in the case of special
exposure groups
3. Selection of comparison groups
• Internal comparison-
2 cigarettes per day Vs 2 packs/day
• External comparison- when information on degree of
exposure not available
Cohort of radiologist Vs Ophthalmologist
• Comparison with general population rate- If none is available,
the mortality experience of the exposed group is compared
with the mortality experience of the general population in the
same geographic area as the exposed people, e.g.,
comparison of frequency of lung cancer among uranium mine
workers with lung cancer mortality in the general population
where the miners resided
4. Follow up
Procedure required are:
• Periodic medical examination of each member
of cohort
• Reviewing physician and hospital records
• Routine surveillance of death records
• Mailed questionnaire or telephone calls
periodic home visits
5. Analysis
• Incidence rate of outcome among
exposed and non exposed
• Estimation of risk
Incidence rate
Estimation of risk
• Relative Risk
• Attributable risk
• Population attributable risk
Relative Risk/Risk Ratio
Incidence amongst exposed

Relative Risk = Incidence amongst non-exposed
Framework
Lung CA No CA lung Total
Smoker 500 500 1000
Non smoker 100 900 1000
Total 600 1400 2000
Incidence amongst exposed = 500/1000 = 50%

Incidence amongst non exposed =100/1000 = 10%
Incidence amongst exposed
Relative Risk = Incidence amongst non-exposed
= 50/10
=5
Smokers have 5 times higher risk of CA lung as
compared to non-smokers
Exposed have _____times higher risk of having
Disease compared to Non-exposed
Relative Risk (RR)
• Direct measure of STRENGTH OF ASSOCIATION
between the suspected cause & effect.
• RR of one indicates no association
• >1 indicates positive association between exposure &
effect.
• Larger the RR, greater the strength of association.
Attributable risk/ Risk Difference
• TO WHAT EXTENT THE DISEASE UNDER STUDY,
ATTRIBUTED TO THE EXPOSURE
• Difference in incidence rates of disease between an

exposed group and non exposed group.
• A.R.=
Incidence of Disease in Exposed (MINUS)- Incidence of
Disease in NOT Exposed x 100…………………………….
Incidence of Disease in Exposed
• 80% of lung cancer cases are due to smoking.

Population Attributable risk
• Difference in incidence rates of disease between an
Population and non exposed group.
• The concept of population attributable risk is useful
in that it provides an estimate of the amount by
which the disease could be reduced in that population
if the suspected factor was eliminated or modified.
• A.R.=
Incidence of Disease in Population (MINUS)-
Incidence of Disease in NOT Exposed x 100
Incidence of Disease in Population
PROSPECTIVE STUDY: PROS & CONS
PROS CONS
• Less variability to • Consistent disease definitions
bias & symptoms.
• Longer time
• No recall
• Common disease only
necessary
• Expensive
• (no recall BIAS) • Ethical concern
• Incidence • A high drop-out rate
determined • Volunteers needed
• Relative risk • A large no. of subjects needed
more accurate
MCQs..
1) A study began in 1970 with a group of 5000
adults in Delhi who were asked about their
alcohol consumption. The occurrence of cancer
was studied in this group between 1990-1995.
This is an example of:
• (a) Cross-sectional study
• (b) Retrospective cohort study
• (c) Concurrent cohort study
• (d) Case-control study
2) TATA memorial hospital conducted a cohort
study on 7000 subjects who were smokers over a
ten-year period & found 70 subjects developed
lung cancer. Concurrent evaluation of general
population in the catchment area of hospital, out
of 7000 non-smoker subjects only 7 developed
lung cancer. The RR for developing lung cancer is:
• (a) 1 Lung cancer No Lung Total
Cancer
• (b) 10 Smoker 70 6930 7000
• (c) 100 Non-smoker 7 6993 7000
• (d) 0.1
3) Several studies have shown that 85% of
cases of lung cancer are due to cigarette
smoking. It is a measure of:
• (a) Incidence rate
• (b) Relative risk
• (c) Attributable risk
• (d) Population attributable risk
4) The incidence of carcinoma cervix in women
with multiple sexual partners is 5 times the
incidence seen in those with a single partner.
Based on this, what is the attributable risk?
• (a) 20%
• (b) 40%
• (c) 50%
• (d) 80%
5) Attribute risk gives a better idea of:
• (a) Strength of association between cause and
effect
• (b) Impact of successful preventive health
programme
• (c) Assessing aetiological role or factor in
disease
• (d) Potential public health importance of
disease
• Answers
1. C
2. B
3. C
4. D
5. B

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Cohort Study..

Design, Steps, Analysis

Dr. Ankush Jagota

02/01/2024 Dr. Nilesh G. Patel 2

• When there is good evidence of an association

• Cohort must be free from the disease under

• General population: When the exposure or cause of

Incidence amongst exposed

Incidence amongst exposed = 500/1000 = 50%

• Difference in incidence rates of disease between an

• 80% of lung cancer cases are due to smoking.

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