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Case–control study

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139:. The results may be confounded by other factors, to the extent of giving the opposite answer to better studies. A meta-analysis of what was considered 30 high-quality studies concluded that use of a product halved a risk, when in fact the risk was, if anything, increased. It may also be more difficult to establish the timeline of exposure to disease outcome in the setting of a case–control study than within a prospective cohort study design where the exposure is ascertained prior to following the subjects over time in order to ascertain their outcome status. The most important drawback in case–control studies relates to the difficulty of obtaining reliable information about an individual's exposure status over time. Case–control studies are therefore placed low in the 107:
breast cancer, were retrospective investigations. Most sources of error due to confounding and bias are more common in retrospective studies than in prospective studies. For this reason, retrospective investigations are often criticised. If the outcome of interest is uncommon, however, the size of prospective investigation required to estimate relative risk is often too large to be feasible. In retrospective studies the odds ratio provides an estimate of relative risk. One should take special care to avoid sources of
180:). The validity of the odds ratio depends highly on the nature of the disease studied, on the sampling methodology and on the type of follow-up. Although in classical case–control studies, it remains true that the odds ratio can only approximate the relative risk in the case of rare diseases, there is a number of other types of studies (case–cohort, nested case–control, cohort studies) in which it was later shown that the 2785: 103:
interest should be common; otherwise, the number of outcomes observed will be too small to be statistically meaningful (indistinguishable from those that may have arisen by chance). All efforts should be made to avoid sources of bias such as the loss of individuals to follow up during the study. Prospective studies usually have fewer potential sources of bias and confounding than retrospective studies.
159:. They showed a statistically significant association in a large case–control study. Opponents argued for many years that this type of study cannot prove causation, but the eventual results of cohort studies confirmed the causal link which the case–control studies suggested, and it is now accepted that tobacco smoking is the cause of about 87% of all lung cancer mortality in the US. 2809: 2797: 93:
As with any epidemiological study, greater numbers in the study will increase the power of the study. Numbers of cases and controls do not have to be equal. In many situations, it is much easier to recruit controls than to find cases. Increasing the number of controls above the number of cases, up to
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defines the case–control study as: "an observational epidemiological study of persons with the disease (or another outcome variable) of interest and a suitable control group of persons without the disease (comparison group, reference group). The potential relationship of a suspected risk factor or an
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in which two existing groups differing in outcome are identified and compared on the basis of some supposed causal attribute. Case–control studies are often used to identify factors that may contribute to a medical condition by comparing subjects who have the condition with patients who do not have
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When the logistic regression model is used to model the case–control data and the odds ratio is of interest, both the prospective and retrospective likelihood methods will lead to identical maximum likelihood estimations for covariate, except for the intercept. The usual methods of estimating more
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Case–control studies are a relatively inexpensive and frequently used type of epidemiological study that can be carried out by small teams or individual researchers in single facilities in a way that more structured experimental studies often cannot be. They have pointed the way to a number of
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A retrospective study, on the other hand, looks backwards and examines exposures to suspected risk or protection factors in relation to an outcome that is established at the start of the study. Many valuable case–control studies, such as Lane and Claypon's 1926 investigation of risk factors for
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A prospective study watches for outcomes, such as the development of a disease, during the study period and relates this to other factors such as suspected risk or protection factor(s). The study usually involves taking a cohort of subjects and watching them over a long period. The outcome of
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Controls need not be in good health; inclusion of sick people is sometimes appropriate, as the control group should represent those at risk of becoming a case. Controls should come from the same population as the cases, and their selection should be independent of the exposures of interest.
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Case–control studies were initially analyzed by testing whether or not there were significant differences between the proportion of exposed subjects among cases and controls. Subsequently, Cornfield pointed out that, when the disease outcome of interest is rare, the
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Controls can carry the same disease as the experimental group, but of another grade/severity, therefore being different from the outcome of interest. However, because the difference between the cases and the controls will be smaller, this results in a lower
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attribute to the disease is examined by comparing the diseased and nondiseased subjects with regard to how frequently the factor or attribute is present (or, if quantitative, the levels of the attribute) in each of the groups (diseased and nondiseased)."
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important discoveries and advances. The case–control study design is often used in the study of rare diseases or as a preliminary study where little is known about the association between the risk factor and disease of interest.
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they tend to be less costly and shorter in duration. In several situations, they have greater statistical power than cohort studies, which must often wait for a 'sufficient' number of disease events to accrue.
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interpretable parameters than odds ratios—such as risk ratios, levels, and differences—is biased if applied to case–control data, but special statistical procedures provide easy to use consistent estimators.
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Rodrigues L, Kirkwood BR (1990). "Case–control designs in the study of common diseases: updates on the demise of the rare disease assumption and the choice of sampling scheme for controls".
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and Gardner claimed that the contributions of medical science to increasing human longevity and public health were negligible, and too often negative, until Scottish physician
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One of the most significant triumphs of the case–control study was the demonstration of the link between tobacco smoking and lung cancer, by
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the condition but are otherwise similar. They require fewer resources but provide less evidence for causal inference than a
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Case–control studies are observational in nature and thus do not provide the same level of evidence as
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Ioannidis JP (2005). "Contradicted and initially stronger effects in highly cited clinical research".
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Grimes DA, Schulz KF (2005). "Compared to what? Finding controls for case–control studies".
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Prentice RL, Pyke R (1979). "Logistic disease incidence models and case–control studies".
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Type of observational study comparing two existing groups differing in outcome
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Miettinen O (1976). "Estimability and estimation in case–referent studies".
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a ratio of about 4 to 1, may be a cost-effective way to improve the study.
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Greenhouse SW (1982). "Jerome Cornfield's contributions to epidemiology".
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Schulz KF, Grimes DA (2002). "Case–control studies: research in reverse".
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of exposure without the need for the rare disease assumption.
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Committee on the Environment, Public Health and Food Safety
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was able to convince the medical establishment to adopt
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The case–control study is frequently contrasted with
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Superforecasting: The Art and Science of Prediction
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(2008). 364: 309: 249: 247: 244: 243: 242: 237: 232: 227: 220: 217: 201: 198: 164: 161: 148: 145: 129:cohort studies 120: 117: 99: 96: 78: 75: 71:cohort studies 58: 55: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 2858: 2847: 2844: 2842: 2839: 2837: 2834: 2833: 2831: 2816: 2815: 2806: 2804: 2803: 2794: 2792: 2791: 2782: 2781: 2778: 2768: 2765: 2763: 2760: 2758: 2755: 2753: 2750: 2748: 2745: 2743: 2740: 2738: 2737:Joseph Lister 2735: 2733: 2730: 2728: 2725: 2723: 2720: 2719: 2717: 2713: 2705: 2702: 2700: 2697: 2695: 2692: 2690: 2687: 2686: 2684: 2682: 2679: 2678: 2676: 2672: 2665: 2661: 2659: 2656: 2654: 2651: 2647: 2644: 2642: 2639: 2637: 2634: 2632: 2629: 2628: 2626: 2622: 2619: 2617: 2616:Health Canada 2614: 2613: 2611: 2607: 2604: 2603: 2601: 2597: 2594: 2592: 2589: 2588: 2586: 2582: 2579: 2578: 2576: 2572: 2569: 2568: 2566: 2565: 2563: 2561:Organizations 2559: 2556: 2548: 2542: 2539: 2537: 2534: 2532: 2529: 2527: 2524: 2522: 2519: 2517: 2514: 2512: 2509: 2507: 2504: 2502: 2499: 2497: 2494: 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2101: 2098: 2096: 2093: 2091: 2088: 2084: 2081: 2080: 2079: 2076: 2072: 2069: 2067: 2064: 2062: 2059: 2057: 2054: 2052: 2049: 2047: 2044: 2043: 2042: 2039: 2035: 2032: 2030: 2027: 2025: 2022: 2020: 2017: 2016: 2015: 2012: 2008: 2005: 2003: 2000: 1999: 1998: 1995: 1993: 1990: 1988: 1985: 1981: 1978: 1977: 1976: 1973: 1972: 1970: 1968: 1964: 1958: 1955: 1953: 1950: 1948: 1945: 1943: 1940: 1938: 1935: 1933: 1930: 1928: 1925: 1923: 1920: 1918: 1915: 1913: 1912:Right to food 1910: 1908: 1905: 1903: 1900: 1898: 1895: 1891: 1888: 1886: 1883: 1881: 1878: 1876: 1873: 1871: 1868: 1867: 1866: 1863: 1861: 1858: 1856: 1853: 1850: 1846: 1845:Mental health 1843: 1841: 1838: 1836: 1833: 1831: 1828: 1826: 1823: 1821: 1818: 1814: 1811: 1809: 1806: 1805: 1804: 1801: 1799: 1796: 1794: 1793:Housing First 1791: 1787: 1784: 1782: 1781:Health system 1779: 1778: 1777: 1776:Health policy 1774: 1772: 1769: 1767: 1764: 1762: 1759: 1757: 1754: 1752: 1749: 1747: 1744: 1740: 1737: 1735: 1732: 1731: 1730: 1727: 1725: 1722: 1720: 1717: 1715: 1712: 1710: 1707: 1705: 1702: 1700: 1697: 1696: 1694: 1690: 1686: 1685:Public health 1679: 1674: 1672: 1667: 1665: 1660: 1659: 1656: 1644: 1643: 1639: 1637: 1636: 1632: 1630: 1629: 1625: 1624: 1621: 1615: 1612: 1610: 1607: 1605: 1602: 1600: 1597: 1595: 1592: 1591: 1589: 1585: 1579: 1576: 1574: 1573:Meta-analysis 1571: 1569: 1566: 1564: 1561: 1559: 1556: 1555: 1553: 1551: 1547: 1541: 1540:Vaccine trial 1538: 1536: 1535:Seeding trial 1533: 1531: 1528: 1526: 1523: 1521: 1518: 1516: 1513: 1511: 1508: 1506: 1503: 1502: 1500: 1496: 1488: 1484: 1480: 1476: 1472: 1468: 1464: 1460: 1456: 1452: 1450: 1446: 1442: 1438: 1434: 1430: 1426: 1424: 1420: 1416: 1412: 1408: 1404: 1400: 1396: 1392: 1388: 1386: 1382: 1378: 1374: 1370: 1366: 1362: 1358: 1356: 1352: 1349: 1347: 1343: 1337: 1334: 1332: 1329: 1327: 1324: 1321: 1317: 1314: 1310: 1307: 1305: 1304:Retrospective 1302: 1301: 1300: 1297: 1295: 1291: 1287: 1284: 1283: 1281: 1278: 1273: 1269: 1261: 1258: 1257: 1256: 1253: 1249: 1246: 1244: 1241: 1239: 1236: 1235: 1234: 1231: 1230: 1228: 1225: 1224:EBM I to II-1 1220: 1216: 1210: 1207: 1205: 1202: 1200: 1197: 1195: 1192: 1190: 1187: 1183: 1180: 1178: 1175: 1174: 1173: 1170: 1169: 1167: 1163: 1159: 1155: 1148: 1143: 1141: 1136: 1134: 1129: 1128: 1125: 1119: 1116: 1115: 1111: 1104: 1102:0-19-502933-X 1098: 1093: 1092: 1085: 1084: 1080: 1074:, esp. ch. 2. 1072: 1068: 1064: 1060: 1056: 1052: 1051: 1046: 1040: 1037: 1032: 1028: 1024: 1020: 1016: 1012: 1008: 1004: 1000: 996: 992: 985: 982: 977: 973: 969: 965: 958: 955: 950: 944: 940: 933: 930: 925: 921: 917: 913: 910:(2): 226–35. 909: 905: 898: 895: 890: 886: 882: 878: 874: 870: 866: 859: 856: 851: 847: 843: 839: 836:(1): 205–13. 835: 831: 824: 822: 818: 813: 809: 804: 799: 795: 791: 787: 783: 779: 772: 769: 764: 760: 755: 750: 746: 742: 738: 734: 730: 723: 720: 715: 711: 706: 701: 697: 693: 689: 685: 681: 674: 671: 666: 662: 658: 654: 650: 646: 643:(2): 218–28. 642: 638: 631: 628: 623: 619: 614: 609: 605: 601: 597: 593: 592:Davey Smith G 586: 583: 578: 574: 569: 564: 560: 556: 552: 545: 542: 530: 526: 520: 518: 514: 509: 505: 501: 497: 493: 489: 485: 481: 474: 471: 466: 462: 458: 454: 450: 446: 442: 438: 431: 429: 425: 420: 414: 409: 408: 399: 396: 391: 385: 381: 377: 371: 369: 365: 360: 356: 352: 348: 344: 340: 336: 332: 328: 324: 320: 313: 310: 298: 294: 289: 284: 280: 276: 272: 268: 261: 254: 251: 245: 241: 238: 236: 233: 231: 228: 226: 223: 222: 218: 216: 214: 210: 206: 199: 197: 193: 191: 187: 186:relative risk 183: 179: 175: 174:relative risk 171: 162: 160: 158: 157:Bradford Hill 154: 146: 144: 142: 138: 133: 130: 125: 118: 116: 114: 110: 104: 97: 95: 91: 89: 83: 76: 74: 72: 67: 64: 56: 54: 52: 48: 43: 39: 35: 30: 19: 2836:Epidemiology 2812: 2800: 2788: 2757:Radium Girls 2752:Typhoid Mary 2439:Microbiology 2309: 2301: 2264: 2185:Epidemiology 2083:Organization 2034:Oral hygiene 2024:Hand washing 2002:Healthy diet 1932:Right to sit 1825:Labor rights 1640: 1633: 1626: 1415:Hazard ratio 1315: 1299:Cohort study 1090: 1048: 1039: 998: 994: 984: 967: 963: 957: 938: 932: 907: 903: 897: 864: 858: 833: 829: 785: 781: 771: 736: 732: 722: 687: 683: 673: 640: 636: 630: 606:(3): 464–7. 603: 599: 585: 561:(3): 78–79. 558: 554: 544: 532:. 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Retrieved 273:(1): 54–60. 270: 266: 253: 203: 194: 166: 153:Richard Doll 150: 134: 126: 122: 105: 101: 92: 84: 80: 68: 62: 60: 37: 33: 31: 29: 2814:WikiProject 2554:and history 2434:Engineering 2147:Vaccination 2019:Food safety 1609:Null result 1568:Replication 1463:Infectivity 1385:Association 1336:Case report 1326:Case series 1309:Prospective 590:Lawlor DA, 113:confounding 2830:Categories 2567:Caribbean 2444:Processing 2378:Quarantine 2300:Student's 2100:Sanitation 1734:History of 1411:Odds ratio 1403:Risk ratio 1369:Prevalence 1355:Occurrence 1331:Case study 964:Biometrika 865:Biometrics 246:References 182:odds ratio 170:odds ratio 57:Definition 51:odds ratio 2747:John Snow 2674:Education 2664:Full list 2552:education 2476:ISO 22000 2429:Chemistry 2342:Epidemics 2295:ROC curve 2105:Emergency 1885:Radiation 1865:Pollution 1849:Ministers 1746:Euthenics 1471:Morbidity 1459:Virulence 1361:Incidence 1071:Q21203378 1063:26682260M 1015:0277-6715 343:0277-6715 2790:Category 2489:sciences 2424:Additive 2095:Safe sex 2066:Medicine 1980:Theories 1751:Genomics 1729:Eugenics 1719:Deviance 1699:Auxology 1635:Glossary 1628:Category 1505:In vitro 1346:Measures 1165:Overview 1067:Wikidata 1031:11387977 1023:12185893 812:15213107 763:13364389 733:Br Med J 714:14772469 684:Br Med J 665:16749356 657:16014596 622:15166201 577:16184164 508:10770936 500:11844534 457:15836892 359:11387977 351:12185893 297:12533370 219:See also 163:Analysis 147:Examples 61:Porta's 2802:Commons 2715:History 2612:Canada 2587:Europe 2071:Nursing 2051:Hygiene 2014:Hygiene 1739:Liberal 1692:General 1510:In vivo 924:1251836 889:7046823 881:2529852 850:2190942 754:2035864 705:2038856 376:Porta M 302:5 March 288:1726024 205:Tetlock 188:or the 2602:India 2577:China 2449:Safety 2130:Worker 1099:  1069:  1061:  1029:  1021:  1013:  945:  922:  887:  879:  848:  810:  803:437139 800:  761:  751:  712:  702:  663:  655:  620:  575:  534:4 July 506:  498:  480:Lancet 465:836985 463:  455:  437:Lancet 415:  386:  357:  349:  341:  295:  285:  2627:U.S. 2471:HACCP 2420:Food 2312:-test 2304:-test 1890:Light 1875:Water 1449:Other 1027:S2CID 877:JSTOR 661:S2CID 504:S2CID 461:S2CID 355:S2CID 263:(PDF) 176:(see 88:power 2403:WASH 2359:List 2347:List 1880:Soil 1288:vs. 1156:and 1097:ISBN 1019:PMID 1011:ISSN 943:ISBN 920:PMID 885:PMID 846:PMID 808:PMID 759:PMID 710:PMID 653:PMID 637:JAMA 618:PMID 573:PMID 536:2019 496:PMID 453:PMID 413:ISBN 384:ISBN 347:PMID 339:ISSN 304:2012 293:PMID 155:and 111:and 109:bias 1870:Air 1003:doi 972:doi 912:doi 908:103 869:doi 838:doi 798:PMC 790:doi 786:328 782:BMJ 749:PMC 741:doi 700:PMC 692:doi 645:doi 641:294 608:doi 563:doi 488:doi 484:359 445:doi 441:365 331:doi 283:PMC 275:doi 2832:: 1485:, 1481:, 1477:, 1473:, 1469:, 1465:, 1461:, 1457:, 1439:, 1435:, 1431:, 1413:, 1409:, 1405:, 1401:, 1397:, 1393:, 1375:, 1371:, 1367:, 1363:, 1292:, 1065:, 1059:OL 1057:, 1053:, 1025:. 1017:. 1009:. 999:21 997:. 993:. 968:66 966:. 918:. 906:. 883:. 875:. 844:. 834:19 832:. 820:^ 806:. 796:. 784:. 780:. 757:. 747:. 735:. 731:. 708:. 698:. 686:. 682:. 659:. 651:. 639:. 616:. 604:33 602:. 598:. 571:. 557:. 553:. 527:. 516:^ 502:. 494:. 482:. 459:. 451:. 439:. 427:^ 367:^ 353:. 345:. 337:. 327:21 325:. 321:. 291:. 281:. 271:20 269:. 265:. 143:. 32:A 2666:) 2662:( 2310:Z 2302:t 1851:) 1847:( 1677:e 1670:t 1663:v 1322:) 1318:( 1279:) 1275:( 1226:) 1222:( 1146:e 1139:t 1132:v 1105:. 1033:. 1005:: 978:. 974:: 951:. 926:. 914:: 891:. 871:: 852:. 840:: 814:. 792:: 765:. 743:: 737:2 716:. 694:: 688:2 667:. 647:: 624:. 610:: 579:. 565:: 559:6 538:. 510:. 490:: 467:. 447:: 421:. 392:. 361:. 333:: 306:. 277:: 20:)

Index

Case control study
observational study
randomized controlled trial
odds ratio
cohort studies
power
bias
confounding
cohort studies
randomized controlled trials
hierarchy of evidence
Richard Doll
Bradford Hill
odds ratio
relative risk
rare disease assumption
odds ratio
relative risk
incidence rate ratio
Tetlock
Archie Cochrane
randomized control trials
Nested case–control study
Retrospective cohort study
Prospective cohort study
Randomized controlled trial
"8. Case–control and cross sectional studies"
doi
10.1136/emj.20.1.54
PMC

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