Epidemiological Studies: A Practical Guide

Following on in the footsteps of its acclaimed and popular predecessor, this new edition builds on the successful features that engaged readers of the first edition: it explains the principles and practice of epidemiology and serves as a handbook for those who wish to do epidemiology; it uses relevant exercises and examples, taken from real life, to illustrate how to set up a study; it aims to help produce valid results that will satisfy grant bodies, ethical committees, and journal editors; ultimately it bridges the gap between theory and practice. This edition includes numerous improvements and several new chapters which will further enhance its appeal.

Scope of this volume

xi

Acknowledgements

xiv

PART I INTRODUCTION

Scope of epidemiological enquiry and overview of main problem areas

3

(10)

What questions can epidemiology answer?

3

(4)

What are the major issues in conducting epidemiological research?

7

(6)

PART II MEASURING THE OCCURRENCE OF DISEASE

Which measure of disease occurrence?

13

(7)

Incidence

13

(3)

Prevalence

16

(1)

Choice of measure

17

(3)

Comparing rates: between and within populations

20

(11)

Introduction

20

(1)

Standardisation

21

(3)

Comparison of rates over time

24

(7)

PART III STUDYING ASSOCIATIONS BETWEEN RISK FACTORS AND DISEASE

Which type of study?

31

(14)

The ecologic study

31

(2)

The migrant study

33

(2)

The cross-sectional study

35

(2)

The case-control study

37

(2)

The cohort study

39

(2)

Choice of study design

41

(4)

Which measure of association?

45

(8)

Relative risks

45

(2)

Odds ratios

47

(1)

Attributable risks

48

(1)

Precision of measures in association

49

(1)

Categorisation of exposures

49

(4)

PART IV SELECTION OF POPULATIONS AND SAMPLES TO STUDY

Studies of disease occurrence. I: Identification of the population

53

(7)

Representativeness

54

(1)

Access

55

(1)

Population data accuracy

56

(1)

Study size

57

(3)

Studies of disease occurrence. II: Assessing disease status in study populations

60

(14)

Approaches to measuring incidence

60

(3)

Use of diagnosed cases: retrospective review or prospective notification?

63

(2)

Defining cases with the catchment population approach

65

(2)

Use of cross-sectional population surveys to assess incidence

67

(1)

Approaches to measuring prevalence

68

(1)

Catchment population methods for measuring prevalence

69

(1)

Population surveys

70

(1)

Other (indirect) measures

71

(3)

Studies of disease causation. I: Selection of subjects for case-control studies

74

(19)

Recruitment of cases

74

(8)

Recruitment of controls

82

(5)

One or two control groups?

87

(1)

Matching

88

(2)

Study size

90

(3)

Studies of disease causation. II: Selection of subjects for cohort (longitudinal) studies

93

(10)

Retrospective or prospective study cohorts?

93

(2)

How should exposure be categorised?

95

(2)

Study size

97

(6)

PART V INFORMATION FROM EPIDEMIOLOGICAL SURVEYS

Collecting information

103

(8)

Interview or subject completing questionnaire?

103

(3)

How to formulate a questionnaire

106

(5)

Obtaining valid information

111

(9)

Introduction

111

(1)

Sensitivity and specificity

112

(3)

Validity for variables that are not dichotomous

115

(1)

Possible approaches for independent validation

116

(2)

Misclassification

118

(2)

Repeatability

120

(8)

Introduction

120

(2)

Study designs to measure repeatability

122

(6)

Maximising participation

128

(10)

Introduction

128

(1)

Reasons for non-participation

128

(4)

Maximising participation in follow-up

132

(6)

Conducting a pilot study

138

(7)

Aims

138

(7)

PART VI ANALYSIS AND INTERPRETATION OF EPIDEMIOLOGICAL DATA

Preparation of survey data for statistical analysis

145

(13)

Introduction

145

(2)

Initial checking for completeness and accuracy

147

(2)

Linkage by subject of data from multiple sources

149

(1)

Development of a data coding schedule

149

(2)

Development of a computer database

151

(2)

Procedure for data entry

153

(1)

Checking for errors in entered data

154

(1)

Missing data

155

(1)

Recoding of entered data

156

(1)

Storage of data and data set

157

(1)

Introductory data analysis: descriptive epidemiology

158

(10)

Introduction

158

(1)

Incidence rates

158

(2)

Prevalence (proportions)

160

(3)

Crude, age-specific and standardised rates

163

(5)

Introductory data analysis: analytical epidemiology

168

(20)

Introduction

168

(2)

Effect measurement, interval assessment and significance testing

170

(1)

Analysis of case-control studies

171

(8)

Analysis of cohort studies

179

(8)

Conclusion

187

(1)

Confounding

188

(13)

Introduction

188

(2)

Minimising confounding in study design

190

(1)

Conduct of study

191

(1)

Analysis

192

(9)

Bias

201

(14)

Introduction

201

(2)

Major sources of bias

203

(1)

Selection bias

204

(5)

Information bias

209

(3)

Is an unbiased study ever possible?

212

(3)

PART VII OTHER PRACTICAL ISSUES

Ethical issues in epidemiology

215

(13)

Introduction

215

(1)

Ethical approval

215

(1)

Ethical constraints in maximising response rate

216

(2)

Confidentiality and data protection

218

(3)

Detection of previously unrecognised disease

221

(4)

Consent

225

(3)

The costs of epidemiological studies

228

(9)

Costs versus design

228

(1)

Costing an epidemiological study

229

(4)

Possibilities for cost containment

233

(2)

Wasting resources

235

(2)

Index

237

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Epidemiological Studies: A Practical Guide

Summary

Table of Contents

Supplemental Materials