Classification of epidemiological

studies: logical thinking in

epidemiology

JUAN FERNANDO SALDARRIAGA FRANCO

GRUPO DE EPIDEMIOLOGA
FACULTAD NACIONAL DE SALUD PBLICA
UNIVERSIDAD DE ANTIOQUIA

KEY POINTS

Scientific illiteracy is a major failing of the medical

and public health education

Studies

indicate an inverse relation between

knowledge of contemporary care and time since
graduation

We need to encourage more critical and thoughtful

consumers of research, and thus better practitioners

Randomised controlled trials are the gold standard in

clinical research: help to eliminate bias

Logical thinking in epidemiology

Epidemiology focused on three key features:

person, place, and time, or, agent, host, and

environment.

Principal Steps

First step: measuring the disease

Second step: generate a hypothesis
Third step: choosing the design

Logical thinking in epidemiology

Analytical approach
Dependent
Variable, Y

Independent
Variables, X

Potential
confounding, Z

A taxonomy of clinical research

A simple hierarchy
can be used

The anatomy determines

what it can and cannot do
Authors sometimes do not
report the study type
Authors sometimes incorrectly
label the type of research done

All evidence indicates the same

Taxonomy of clinical research:

the basic questions

What studies can and cannot do:

Is the study design appropriate for the question?

What studies can and cannot do:

Is the study design appropriate for the question?

Descriptive studies:
Describe the
Hypotheses Do not have a
frequency,
can be
comparison
Starting at
natural
assessed
the bottom of history, and
group, do not
the research
through more
allow
possible
hierarchy
rigorous
assessment of
determinants
research
associations
of a condition

What studies can and cannot do:

Is the study design appropriate for the question?

Cross-sectional study:
a snapshot in time
Sometimes termed
Outcome and
a frequency survey
exposure are
or a prevalence
ascertained at the
same time
study

Temporal relation
Unclear:
Obesity and
Artrithis?

What studies can and cannot do:

Is the study design appropriate for the question?

Cohort study:
looking forward in time
Logical
sequence:
from
exposure to
outcome

Follow the
exposed and
unexposed
groups
forward in
time

Exposed
group
develops a
higher
incidence,
then the
exposure is
associated

Enables
calculation of
true
incidence
rates, relative
risks, and
attributable
risks

What studies can and cannot do:

Is the study design appropriate for the question?

Case-control study:
thinking backwards
Starting
with an
outcome,
looks
backward
in time for
exposures

Prevalence
Especially
exposure is
useful for
higher among
outcomes
cases than
that are rare
among
or that take a
controls, then
long time to
the exposure
develop
is associated

Controls
should be
similar to
cases, except
for not
having the
outcome

What studies can and cannot do:

Is the study design appropriate for the question?

Non-randomised trial:
penultimate design?
Do not randomly
allocate
participants to
exposures

The way a
non-randomised
Designate this
trial is done
research
and analysed
design as class II-1
resembles that of a
cohort study

What studies can and cannot do:

Is the study design appropriate for the question?

Randomised controlled trial:

gold standard
It resembles
Feature
The only
Especially
the cohort
uniform
known way
useful for
diagnostic
study in
examination
to avoid
criteria
several
of small or
selection and
respects,
for outcomes
moderate
confounding
exception
and, often,
effects
biases
blinding
randomisation

Measurement of outcomes:
Confusing fractions

Importance of deep analysis

Importance of deep analysis