‫بسم ال الرحن الرحيم‬

In the Name of Allah, the Most

Gracious, the Most Merciful
Case-Control Study
(Retrospective Study; Case-
referrant Study; Case-history
(Study
(‫ الدراسات الرتعة‬،‫(الدراسات التتبعية للخلف‬

‫دراسة الالت الرضية والجموعة الضابطة‬

 Case-Control Study
Definition:
• A study in which groups of individuals
are selected in terms of whether they
do have the disease (i.e. cases( or do not
(i.e. controls( and these are compared
with respect to exposure or factor
relevant to the etiology of disease.
Case-Control Study
• The objective from conducting a case-control
Study is to test the hypothesis that an
exposure (a factor, suspected cause or risk
factor( is associated with a disease, i.e.:
• To determine the causal association between
exposure and disease
 What is a Hypothesis?
• A Hypothesis is a testable
preposition which can be accepted
or rejected through well-designed
epidemiological studies.

‫• الفرضية‬
 Study Design
1. Select cases of disease:
• Newly diagnosed cases
• In one or more hospitals, clinics,
medical centers
• Cases identified should be
representative of disease status in the
community
 Study Design (Cont.(
2. Select a control group:
• Patients within the same medical care
facility
• A sample of general population
• Friends or acquaintances
• Fellow employees
• Neighbours
• Family members
 Control group
• Involves sampling:
– A sample of patients in the same hospital
where cases were selected
– A sample of the general population in a
community
3. Ensure comparability of cases & controls,
e.g., of same age, sex, socioeconomic status
to reduce bias (error(
 Study Design (Cont.(
4. Collect information about exposure:
• Interviews with cases and controls
• Hospital records
• Employment records
 Study Design (Cont.(
Exposure +ve Cases

Exposure -ve
Exposure +ve Controls

Exposure -ve
In the Past <---------- Onset of Study
 Study Design (Cont.(
5. Data analysis:
• Determine presence or absence of exposure
in cases & controls
• Construct 2X2 table
• Measure the association between exposure
and disease, i.e.,
• The measure of association is called Odds
Ratio (OR(
 5. Data analysis
Disease
Cases Controls Total
+ve a b a+b
exposure
- ve c d c+d

-------------------------------
Total a+c b+d a+b+c+d
 5. Data analysis (2X2 Table(
• In a cohort study: relative risk or RR (the measure of
association( =
a
------
a+b
-------------
c
--------
c+d
• In the general population “a” is very small relative to
“b”. Similarly, “c” ” is very small relative to “d”.
• Thus, In the general population: a/a+b ~ a/b and
c/c+d ~ c/d . Consequently the formula reduces to:
a/b ad
----- = ---- = odds ratio (OR(
c/d bc
 5. Data analysis (2X2 Table(

Rate of exposure among cases

• OR = -------------------------------------
Rate of exposure among control

a/c ad
=--------- = ----
b/d bc
 Study Design (Cont.(
6. Interpret the results:
• Positive association
• No association
• Negative association
 Study Design (Cont.(
6. Interpret the results
• If the proportion of exposed among the
cases of disease is the same as the
proportion of exposed among the control
group, then the OR will be one. Therefore:
• If the OR is 1 = there is no association
• If the OR is >1 = there is a + ve assoc., I.e.
Exposure causes disease
• If the OR is <1 = there is a - ve assoc. , I.e.
Exposure protects from disease
 Study Design (Cont.(
6. Interpret the results
• Interpretation of a + ve association:
• If the OR is bet. 1 - 1.9 = weak assoc.
• If the OR is bet. 2 - 3.9 = moderate assoc.
• If the OR is bet. > 4 = strong assoc.
Case-control Study (Example(
Smoking & Lung Cancer
• 100 men with lung cancer and 100 controls,
of similar age & sex, are interviewed
regarding smoking history.
• Hypothesis: Cigarette smoking is associated
with development of lung cancer.
• Among the cases 80 were smokers & among
the controls 30 were smokers.
• Q. Is there any association between smoking
and lung cancer? (Show your 2X2 table &
calculations(
Case-control Study (Example(
Smoking & Lung Cancer
Disease
Cases Controls Total
Smok.+ve 80 30
exposure
Smok.- ve 20 70
-------------------------------
Total 100 100
Case-control Study (Example(
Smoking & Lung Cancer
ad 80 x 70 5600
• Odds ratio (OR( = --- = ---------- = ------
bc 30 x 20 600
= 9.3
• Interpretation:
• This a + ve association
• The risk of lung cancer in smokers is 9.3
times compared to nonsmokers
• It is a strong association OR > 3.9
• Therefore most probably smoking causes
lung cancer
 Case-control Study
Advantages & Disadvantages
(1( Advantages:
• Relatively inexpensive
• Relatively quick results
• Smaller number of subjects
• Suitable for rare disease
• Ethical problems minimal
 Case-control Study
Advantages & Disadvantages
(2( Disadvantages:
• Problems of selecting appropriate
control group
• Problems of comparability
• Incomplete information
• Biased recall
• Yields only estimated relative risk
(OR(
 Case-control Study
Examples
• Cancer(of various sites( & Atomic
Bomb explosion
• Lung cancer & cigarette smoking
• Congenital malformations & drugs in
early pregnancy
• Leukemia & exposure to radiation
• Liver cancer & hepatitis B
 Thank You for
Listening
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‫الستماع‬