Case-Control Study
• Community Medicine / Epidemiology
• Your Name, Roll No, Date
Introduction
• • Observational analytic study design
• • Compares people with a disease (cases) to
those without (controls)
• • Aim: Identify exposures associated with
disease occurrence
Basic Design
• • Select cases (disease present)
• • Select controls (disease absent)
• • Look back retrospectively for exposure
history
Characteristics
• • Retrospective in nature
• • Suitable for rare diseases
• • Studies multiple risk factors for a single
disease
• • Quick, inexpensive compared to cohort
studies
Steps in Conducting
• 1. Define study population
• 2. Select cases (with disease)
• 3. Select controls (without disease)
• 4. Assess exposure history
• 5. Analyze using Odds Ratio
Measures of Association
• • Odds Ratio (OR) = (ad)/(bc)
• • OR = 1 → No association
• • OR > 1 → Risk factor
• • OR < 1 → Protective factor
Advantages
• • Good for rare diseases
• • Requires smaller sample size
• • Multiple risk factors can be studied
• • Relatively cheap & quick
Disadvantages
• • Cannot directly calculate incidence
• • Not ideal for rare exposures
• • Recall bias, selection bias common
• • Temporal relationship unclear
Bias in Case-Control Studies
• • Selection bias – improper control selection
• • Recall bias – cases remember exposures
better
• • Observer bias – interviewer influence
• • Reduce by blinding, proper control selection,
standard questionnaires
Example
• • Smoking and Lung Cancer
• - Cases: Patients with lung cancer
• - Controls: Patients without lung cancer
• - Compare smoking history → Odds Ratio
Applications in Community
Medicine
• • Disease outbreak investigations
• • Identifying risk factors for NCDs
• • Evaluating preventive measures
Summary
• • Retrospective, analytic study
• • Main measure = Odds Ratio
• • Useful for rare diseases & outbreak
investigations
• • Limitations: bias, cannot measure incidence
References
• • Park’s Textbook of Preventive and Social
Medicine
• • CDC Epidemiology Notes