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Taxonomi Penelitian

Epidemiologi
Taxonomi Penelitian Epidemiologi

Berdasarkan tujuan:
Berdasarkan bingkai waktu
Berdasarkan ada tidaknya perlakuan
Berdasarkan penelusuran sebab-akibat
Berdasarkan pengambilan informasi faktor
sebab & akibat
Berdasarkan tujuan

Descriptive studies
Mendeskripsikan kejadian suatu
outcome

Analytic studies
Mendeskripsikan asosiasi antara
exposure dan outcome
Berdasarkan tujuan

Epidemiologi Deskriptif
Menjelaskan distribusi masalah kesehatan
terutama berdasarkan faktor orang,
tempat dan waktu

Epidemiologi Analitik
studi mengenai determinants dari
masalah kesehatan
Berdasarkan tujuan

1. Diskriptif:
a. Laporan kasus
b. Seri kasus
c. Studi kros-seksional
d. Studi ekologi
2. Analitik:
a. Kasus-kontrol
b. Kohort
c. Studi intervensi
Berdasarkan bingkai waktu
(outcome dgn mulainya penelitian)
Timeframe of Studies
Prospective Study - looks forward,
looks to the future, examines future
events, follows a condition, concern or
disease into the future

time

Study begins here


Timeframe of Studies
Retrospective Study - to look back,
looks back in time to study events that
have already occurred

time

Study begins here


Prospective cohort study
Disease
Exposure Study starts occurrence

time

Disease
Study starts Exposure occurrence

time
Retrospective cohort studies

Disease
Exposure occurrence Study starts

time

Case study
Salmonella in Belfast
Case control study

Exposure
? Disease
? Controls

Retrospective nature
Berdasarkan ada tidaknya
perlakuan
Experimental
Peniliti mempunyai kontrol terhadap
pemaparan

Observational
Peneliti mengamati pemaparan yg terjadi
secara secara alamiah (Peneliti tidak
memanipulasi pemaparan)
Berdasarkan ada tidaknya
perlakuan

a. Penelitian observasional:
1. Penelitian diskriptif
2. Kasus-kontrol
3. Studi kohort

b. Penelitian intervensi:
1. Trial/eksperimental
2. Penelitian kuasi eksperimental
Intervention Trials
General Structure [2]
Defined Population

Randomized
Treatment Placebo

Improved Not improved Improved Not improved


Berdasarkan penelusuran sebab-
akibat
a. Tak ada:
- Penelitian diskriptif

b. Ada:
1. Ke depan (forward looking): dari exposure ke
outcome
a. Kohort prospektif
b. Kohort retrospektif
c. Studi intervensi

2. Ke belakang (backward looking) dari outcome


ke exposure
a. Kasus-kontrol
Berdasarkan pengambilan
informasi faktor sebab & akibat
1. Informasi status sebab & akibat pada saat
yang sama: Studi kros-seksional

2. Informasi status sebab & akibat pada saat


yang berbeda (sebab yg terjadi waktu yg
lalu atau sedang berjalan):
Studi longitudinal:
a. Studi kasus-kontrol
b. Studi kohort
c. Studi intervensi
Longitudinal vs. Cross-sectional
Consider effect of smoking on lung cancer
Longitudinal study
Investigator classifies people into smokers (E+)
and non-smokers (E-) as of 1970
Investigator compares incidence of lung cancer in
E+ and E- group accrued between 1980 and 2000

Cross-sectional study
Investigator classifies people into ever-smokers
(E+) and never-smokers (E-)
Investigator compares incidence or prevalence of
lung cancer in E+ and E- group
Study Designs in Epidemiology
STUDY
DESIGNS

Analytical Descriptive

Case report (E.g. Cholera)


Case series
Observational Experimental
Cross-sectional
1. Cross-sectional
Clinical trial (parc vs.
2. Cohort aspirin in Foresterhill) + Follow-up studies if the aim is just
3. Case-control estimating incidence
Field trial (preventive
4. Migrant programmes )
5. Ecological
6. Nested case-control
Main Observational Study Designs

Cross-sectional survey
Assess exposure and outcome simultaneously

Cohort study
Known exposure, assess (future) outcome

Case-control study
Known outcome, assess prior exposure
Main Observational Study Designs

PAST PRESENT FUTURE


Time
Assess exposure
Cross-sectional study and outcome

Assess Known
Case-control study exposure outcome

Known Assess
Prospective cohort exposure outcome

Known Assess
Retrospective cohort exposure outcome
Cross-Sectional Studies (main points)

Step number one in studying any


potential association

Simultaneously
Temporality of the relationship can not be tested.
Exposure constant, outcome not rare.
Prevalences are compared (prevalence ratio), but
incidence can not be estimated.
Study Design Exercise

DZ
-

DZ

Cross-Sectional Study
Study Design Exercise

DZ

E
DZ

DZ
DZ
E

- DZ

Cohort Study
Cohort studies

exposed

unexposed
Cohort studies

exposed

Incidence among
exposed

unexposed

Incidence among
unexposed
Cohort Studies (Main points)
Resources
Relative Risk (risk ratio or rate ratio)
Methodological ideal for the examination of a causal association
Measures disease incidence in exposed and non-exposed
Measuring exposure precedes the disease (no recall bias)
Multiple outcomes (and, sometimes, multiple exposures)
Not suitable for rare diseases
Non-participation or lost to follow-up (selection bias)
Analysis of cross-sectional and cohort
studies (2)

In Cross-sectional study we calculate

1. Prevalence in the exposed group, then


2. Prevalence in the non-exposed group, then
3. Prevalence ratio

In a cohort study we calculate

1. Incidence in the exposed group, then


2. Incidence in the non-exposed group, then
3. relative risk ( risk ratio or rate ratio)
Study Design Exercise

DZ
E

E -

DZ

Case-Control Study
Epidemiologic Study Designs

Validity
*intervention trial
*prospective cohort study
*retrospective cohort study
*nested case-control study
*case control study
*cross-sectional study
*ecological study
*case series
*anecdotes Cost
Design options in epidemiologic research
Type of study Alternate name Unit of study
Observational studies
Descriptive studies
Analytical studies
Ecological Correlational Populations
Cross-sectional Prevalence Individuals
Case-Control Case-Reference Individuals
Cohort Follow-up/ Longitudinal Individuals
Experimental/ intervention Studies
Randomized Controlled Clinical Trial Patients
Studies

Field Trial Healthy person


Community Trial Community intervention studies Communities
39
Deciding which one to use
The investigator observes the Observational study
events without altering them

NO Example: Comparing the history of


needle sharing among IV drug abusers
who have HIV antibodies with those who do not
Decision # 1
Alter the events under study?

Example: Impact of health education


Yes on needle sharing habits

The investigator applies an intervention,


& observes the effect on the outcome
Experimental study

PRD-40
Deciding which one to use
Each subject is examined Cross-sectional study
on only one occasion

NO Example: Study of needle sharing habits


and HIV antibodies measured at the
For observational studies same time
Decision # 2
Make measurements on more
than one occasion? Example: Cohort study that assesses
current needle sharing habits of group of
IV drug abusers and observes who
Yes
subsequently develop HIV antibodies

Each subject is followed over


A period of time
Longitudinal study

PRD-41
Comparison of three analytic strategies

Cohort Case-control

PRD-42
Choice of strategy

PRD-43
PRD-44
Advantages & disadvantages of different
observational study designs

PRD-45
Relative ability of different types of
study to prove causation

PRD-46