CASE CONTROL
A study that compares patients who have a disease or outcome of
interest (cases) with patients who do not have the disease or outcome
(controls), and looks back retrospectively to compare how frequently
the exposure to a risk factor is present in each group to determine the
relationship between the risk factor and the disease.
Case-co. ,t,""u( ~ ie.s
co,trols
CASE CONTROL
Case control studies are also known as "retrospective
studies" and "case-referent studies.
These studies are designed to estimate odds. The odds of an
event represent the ratio of the (probability that the event
will occur) I (probability that the event will not occur)
• Case : A person in the population or study group
identified as having the particular disease, health
disorder or condition under investigation.
• Contro l: Person or persons in a comparison group that
differs, in disease experience (or other health related
outcome) in not having the outcome being studied.
Features of case controls study
• Both exposure and outcome has happened
before the start of the study.
• The study proceeds backwards from effect to
cause.
• It uses a comparison group to support or
refute an inference.
Design of a case-control study
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Hallmark of Case Control Study:
from cases and controls and searches for exposure.
Cancer patients
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Control group
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Steps in Case Control Study
• Selection of cases and controls
• Matching
• Measurement of exposure
• Analysis and interpretation
Selection of controls
• Controls must be free from disease under study
• Must be similar to the cases except for the disease
under study
• Selection of controls is the most difficult
• Sources of controls
-Hospitals
- General population
-Relatives
- Neighborhood
2. Matching
• Matching is a process in which we select controls in
such a way that they are similar to cases with regard to
certain pertinent variables (eg. age) which are known to
influence the outcome of disease and which if not
adequately matched for comparability could
misrepresent or confound the results.
What is a confounding factor?
Alcohol
Esophageal cancer
Smoking
3. Measurement of exposure
• Interviews
• Questionnaires
• Past records
- Hospital records
- Employment records
Analysis
• Find out
- Exposure rates among cases and controls to
suspected factor
- Estimation of disease risk associated with
exposure ( Odds Ratio)
Exposure rates
A case control study between smoking and lune cancer
Cases Controls ( without Total
(with Ca Lung) Ca lung)
Smokers 33 55 88
( <5/day) (a) (b) (a+b)
Non-smokers 2 27 29
(c) (d) (c+d)
Total 35 82 117
(a+c) (b+d) (a+b+c+d)
Exposure rates
A case control study between smoking and lune cancer
Cases Controls ( without Total
(with Ca Lung) Ca lung)
Smokers 33 55 88
( <5/day) (a) (b) (a+b)
Non-smokers 2 27 29
(c) {d) (c+d)
117
I
Total
(a+b-tt:+d)
Exposure rates
• Cases= a/(a+c)= 33/35= 94.2 %
• Controls= b/(b+d)= 55/82= 67 %
• So frequency of smoking was definitely higher
among lung cancer patients than those
without cancer
• Odds Ratio / Relative odds
- Odds: Odds of an event is defined as the ratio of the
number of ways an event can occur to the number of
ways an event cannot occur.
- Odds ratio: Ratio of the odds that the cases were
exposed to the odds that the controls were exposed.
Outcomes of Case Control Study
• Odds ratio:
jDiseased/ cases Not diseased/
-
Controls
Exposed a b
Not exposed C d
Odds that case was exposed
Odds ratio=
Odds that control was exposed
= (a/c)/ (b/d) = ad/ be
Estimation of risk
• Odds that cases were exposed= a/c
• Odds that controls were exposed=
b/d
• Odds ratio= (a/c)/(b/d)= ad/be= 8.1
Interpretation
• Smoking was found be associated
8.1 times more in patients with lung cancer
than those without lung cancer.
Advantages
• Good for studying rare conditions or diseases
• Less time needed to conduct the study because the
condition or disease has already occurred
• Simultaneously look at multiple risk factors
• Can answer questions that could not be answered
through other study designs
Disadvantages
• Retrospective studies have more problems with data quality
because they rely on memory and people with a condition will be
more motivated to recall risk factors (also called recall bias).
• It can be difficult to find a suitable control group
• Incidence cannot be measured
• Not suitable for evaluation of Rx.
