CASE-CONTROL STUDY
By Sirin Javed
CONTENTS
1. INTRODUCTION 2. ADVANTAGES
3. DISADVANTAGES AND LIMITATIONS 4. FUNCTION
5. ISSUES OF CONCERN 6. CLINICAL SIGNIFICANCE
7. ENHANCING HEALTHCARE TEAM
OUTCOMES
1. INTRODUCTION
For example, a researcher may want to look at the
A study that compares two groups of people: those
rare cancer Kaposi's sarcoma. The researcher would
with the disease or condition under study (cases)
find a group of individuals with Kaposi's sarcoma
and a very similar group of people who do not have
(the cases) and compare them to a group of
the disease or condition (controls). Researchers
patients who are similar to the cases in most ways
study the medical and lifestyle histories of the
but do not have Kaposi's sarcoma (controls). The
people in each group to learn what factors may be
researcher could then ask about various exposures
associated with the disease or condition. For
to see if any exposure is more common in those
example, one group may have been exposed to a
with Kaposi's sarcoma (the cases) than those
particular substance that the other was not. Also
without Kaposi's sarcoma (the controls). The
called retrospective study.
researcher might find that those with Kaposi's
sarcoma are more likely to have HIV, and thus
conclude that HIV may be a risk factor for the
development of Kaposi's sarcoma.
2. ADVANTAGES
STUDYING RARE DISEASES
• The case-control approach allows for the study of rare diseases.
• If a disease occurs very infrequently, one would have to follow a large group of people for a long period of
time to accrue enough incident cases to study.
• A case-control study can be useful for identifying current cases and evaluating historical associated
factors.
MULTIPLE RISK FACTORS
• The case-control study design makes it possible to look at multiple risk factors at once.
• For example, in the case of Kaposi's sarcoma, the researcher could ask both the cases and controls about
exposures to various potential risk factors.
RESPONSE TO DISEASE OUTBREAKS
• Case-control studies can also be very helpful when disease outbreaks occur, and potential links and
exposures need to be identified.
UNEQUAL NUMBERS OF CASES AND CONTROLS
• In a case-control study, the investigator can include unequal numbers of cases with controls such as 2:1 or
4:1 to increase the power of the study.
3. DISADVANTAGES AND LIMITATIONS
RECALL BIAS
• The most commonly cited disadvantage in case-control studies is the potential for recall bias.
• Recall bias in a case-control study is the increased likelihood that those with the outcome will recall and
report exposures compared to those without the outcome.
ESTABLISHING CAUSATION
• Case-control studies can be used to establish a correlation between exposures and outcomes, but cannot
establish causation.
FINDING AN APPROPRIATE CONTROL GROUP
• The researcher must find an appropriate control group that shares similar characteristics with the case
group to enhance the validity of the study.
CONFOUNDING VARIABLES
• The researcher must recognize the potential for failing to identify confounding variables or exposures.
4. FUNCTION
The major method for analyzing results in case-control studies is the odds ratio (OR). The odds ratio is the odds
of having a disease (or outcome) with the exposure versus the odds of having the disease without the exposure.
ODDS RATIO CALCULATION
Exposure Status Disease Present Disease Absent
Exposed a b
Not Exposed c d
Odds Ratio = [ (Number exposed with disease) x (Number not exposed without disease) ] / [ (Number
exposed without disease) x (Number not exposed with disease) ]
INTERPRETATION OF ODDS
RATIO
1 An odds ratio of greater than one implies the disease is more
likely with exposure.
2 An odds ratio of less than one implies the disease is less likely
with exposure and thus the exposure may be protective.
5. ISSUES OF CONCERN
The main issues of concern with a case-control study are recall bias, its retrospective nature, the need for a
careful collection of measured variables, and the selection of an appropriate control group.
6. CLINICAL SIGNIFICANCE
A case-control study is a good tool for exploring risk factors for rare diseases or when other study types are not
feasible.
An investigator will hypothesize a list of possible risk factors for a disease process and will then use a case-
control study to see if there are any possible associations between the risk factors and the disease process.
The investigator can then use the data from the case-control study to focus on a few of the
most likely causative factors and develop additional hypotheses or questions.
7. ENHANCING HEALTHCARE TEAM
OUTCOMES
Case-control studies are prevalent in all fields of Each part of the health care team has roles to
medicine from nursing and pharmacy to use in contribute to such studies, especially in identifying
public health and surgical patients. correct controls for the cases.
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