病例对照与回顾性队列研究

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1、RobertE.Fontaine,MD,MScBao-PingZhu,MD,MSUSExpertAdvisorstoChineseFETP病例对照与回顾性队列研究Case-ControlandRetrospectiveCohortStudiesEpidemiology:The“CDC”ApproachC=Count2D=DivideC=CompareProposedby:WilliamFoege,MD,MPH,Director,USCDC(1977-1983)WilliamFoege,MD,MPHCase-controlCohortIndividualsInt

2、erventionRetrospectiveProspectiveDescriptivePopulationsAnalyticalObservationalCase-seriesCross-sectionalEcologicClinicaltrials流行病学研究Epidemiologicalstudies有了初步假设，并已经进行了以下步骤。下一步要做什么？Youhaveahypothesisandthefollowing.Whatnext?疾病特征DiseaseCharacteristics+时间分布Timedistribution+地区分布Placedist

3、ribution+人群分布Persondistribution+通过访谈建立假设Hypothesisgeneratinginterviews+考虑异常值Outliers=得到关于暴露的假设possibleexposure针对假设的暴露因素，对率进行比较WecompareratesbyourhypothesizedexposuresWhatdoweneedtodothis?对可疑的暴露进行准确的测量Weobtainaccuratemeasurementsontheexposureofinterest访谈Interviews查阅记录Writtenrecords测量M

4、easurements实验室检测Laboratorytests环境数据Environmentaldata在病例对照和回顾队列研究中，从疾病开始，回溯暴露Incase-controlandretrospectivecohortstudieswebeginwiththediseaseandlookbacktotheexposure.ExposureDiseaseTimeReferentexposureperiodStudybegins在人群中，某种暴露与疾病的关系Therelationshipbetweenexposureandcasesinapopulatio

5、nDisease疾病Exposure暴露+-Total合计罹患率ARx+ABA+BA/(A+B)Reference参照-CDC+DC/(C+D)Total合计A+CB+DA+B+C+D人群罹患率PopulationAR=(A+C)/(A+B+C+D)根据人群数据进行一些基本的流行病学比较BasicepidemiologiccomparisonsfromthepopulationdataRiskDifference:[A/(A+B)]–[C/(C+D)]RiskRatio:[A/(A+B)]/[C/(C+D)]=(AC+AD)/(AC+BC)OddsRatio:(

6、A/B)/(C/D)=(A/C)/(B/D)=AD/BCDisease疾病Exposure暴露+-Total合计罹患率ARx+ABA+BA/(A+B)Reference参照-CDC+DC/(C+D)Total合计A+CB+DA+B+C+DDisease疾病Exposure暴露+-Total合计ARx+50950100050/1000Reference参照-10990100010/1000Total合计601940200060/2000Riskdifference:[50/1000]–[10/1000]=40/1000RiskRatio:[50/1000]/[10

7、/1000]=5.0根据人群数据进行一些基本的流行病学比较Basicepidemiologiccomparisonsfromthepopulationdata从同一2X2表也可以计算奥值和奥值比Oddsandoddsratiosmaybecalculatedfromthesame2x2tableDisease疾病Exposure暴露+-疾病奥值Oddsofdisease+ABA/B-(Reference参照)CDC/D暴露奥值OddsofexposureA/CB/D暴露的奥值比Oddsratioexposure=(A/C)/(B/D)=AD/BC疾病的奥值比Od

8、dsratiodisea