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COHORT

cohort study ; klpk tentara yg berbaris


maju ke medan perang
 Merup studi epidemiologis analitik non eksperimental
yg mempelajari hub antara faktor risiko dg efek /
penyakit
 Information on exposure is known for all subjects at
the beginning of the follow up period  enrollment of
currently exposed and non-exposed individual
(prospective)
 prospective (present and future) or retrospective
(historical cohort study -- using secondary data)
cohort study

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MACAM-MACAM PENELITIAN
PROSPECTIVE / STUDI KOHORT
 Concurrent prospective studi (cohort, longitudinal)
 Exposure & non exposure dicari pada saat sekarang
 Klmpk studi di follow up utk bbrp waktu & insidens diukur

 Non concurrent prospective studi (retrospective cohort)


 Exposure dicari dari catatan medik yg obyektif dimasa lalu

 Outcome di cari pada saat sekarang

 Kombinasi antara concurrent dg non concurrent


 Exposure didapat dari catatan medik yg objektif dimasa lalu

 Follow up dan pengukuran outcome dilanjutkan ke depan

 Nested case-control study


 Exposure diperiksa / dicari setelah studi kohort selesai
MACAM-MACAM BIAS YG MUNCUL
DLM STUDI PROSPECTIVE
 Bias seleksi : exsposed & non exsposed
 Bias informasi : terutama pada studi non-
concurrent  pencatatan pd medical record
tdk lengkap
 Bias dlm penilaian outcome
 Bias non-response : sampel yg mundur
 Bias analysis
KAPAN STUDI PROSPECTIVE ITU
MENJANJIKAN ?
 Apabila ada bukti yg baik adanya hub antara suatu penyakit dg
exposure (dari observasi klinik & studi kasus kontrol)

 Apabila eksposure itu jarang terjadi ttp insiden dari suatu


penyakit diantara kelompok itu tinggi (klpm tt : industri, radiasi)

 Apabila waktu antara exposure & penyakit itu pendek (misalnya


infeksi selama kehamilan & malformasi bawaan dari bayi)

 Apabila tersedia banyak uang

 Apabila peneliti mempunyai life ecpectancy panjang


ANALISIS DASAR STUDI
KOHORT
Efek Efek Jumlah
Ya Tidak
Risiko a b a+b
Ya
Risiko c d c+d
Tidak
Jumlah a+c b+d a+b+c+d

Resiko Relatif / RR = a/(a+b) : c/(c+d)


RR menunjukkan berapa kali insidens pd subyek dg f.
risiko lebih tinggi dibdg insidens pd subyek tanpa f. risiko
SKEMA MEMPERJELAS
PERBEDAAN DESAIN

Cross-sectional
Cross-sectional Cross-sectional

Kasus kontrol
Kohort prospektif

Kohort retrospektif

MASA LALU SEKARANG MASA DATANG


COMPARISONS OF CASE-CONTROL AND
PROSPECTIVE STUDIES

Case-control P Concurrent P Non-concurrent


studies

Study group Persons with Exposes persons Exposes persons


disease (a+b) (a+b)
(cases)(a+c)
Comparison Persons wirhout Non-exposed Non-exposed
group disease (control) persons (c+d) persons (c+d)
(b+d)
Outcome Proportion of Incidence in the Incidence in the
measureme cases exposed exposed exposed
nts
Proportion of Incidence in the Incidence in the
control exposed non-exposed non-exposed
COMPARISONS OF CASE-CONTROL AND
PROSPECTIVE STUDIES

Case-control studies P Concurrent P Non-concurrent

Measure of risk Odds ratio Absolute risk Absolute risk


Atrributable risk Relative risk Relative risk
Odss ratio Odss ratio
Atributable risk Atributable risk
Temporal Sometimes hard to Easily established Sometimes hard to
relationship establish establish
between
exposure &
disease
Multiple Can study Can study Can study associations of
association associations of a associations of an an exposure with several
disease with several exposure with several disease
exposure or factors disease
COMPARISONS OF CASE-CONTROL AND
PROSPECTIVE STUDIES

Case-control P Concurrent P Non-concurrent


studies

Length of Relatively short Generally long May be short


study

Cost of Relatively Expensive Generally less


study inexpensive expensive then a
concurrent study
Population Relatively small Relatively large Relatively large
size
needed
Potential Assesment of Assesment of Susceptible to bias
bias exposure outcome both in assesment of
exposure and
assesment of
outcome
COMPARISONS OF CASE-CONTROL AND
PROSPECTIVE STUDIES

Case-control studies P Concurrent P Non-concurrent

Best when Disease is rare Exposure is rare Exposure is rare


exposure is common disease is frequent disease is frequent
among the disease among exposed among exposed

Problems Selection of Selection of non- Selection of non


appropriate controls exposed comparison exposed comparison
often dificult group often difficult group often difficult

Incomplete Lost to follow up Lost to follow up


information on
exposure Changes overtime in Changes overtime in
criteria and methods criteria and methods
nested case – control study
 A combination of cohort and case-control design, or a
case control study nested in a cohort study

 A candidate population, without reference to study


factor information, is followed until the detection of
cases. The cases are then compared to the non-cases
with respect to exposure of interest

 eliminate recall bias


nested case – control study

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KEUNTUNGAN NESTED CASE-
CONTROL STUDY
1. Kemungkinan bias recall dapat dieliminir krn data
ttg exposure didapat sblm penyakit muncul
2. Data exposure kemungkinan lebih representatif
thdp keadaan sblm sakit krn data tsb didpt bbrp
wkt sblm ada gejala-gejala klinis
3. Biaya lebih murah dibandingkan studi cohort krn
test laboratorium hanya perlu dilakukan thdp
spesimen dari subyek-subyek yg terpilih sbgi
kasus dan kontrol
KELEBIHAN STUDI KOHORT

1. Studi terbaik dlm menentukan insidens &


perjalanan penyakit atau efek yg diteliti
2. Desain terbaik dlm menerangkan dinamika hub
antara faktor risiko dg efek scr temporal
3. Merup pilihan terbaik utk kasus yg bersifat fatal &
progresif
4. Dapat meneliti beberapa efek sekaligus dari suatu
faktor risiko tt
5. Pengamatan dilakukan scr kontinue & longitudinal
: dpt meneliti berbagai mslh kes yg makin
meningkat
KELEMAHAN STUDI KOHORT

1. Memerlukan waktu yg lama


2. Sarana & biaya mahal
3. Rumit
4. Kurang efisien dari segi waktu & biaya utk meneliti
kasus yg jarang
5. Drop out tinggi
6. Pd keadaan tt dpt menimbulkan mslh etika krn
peneliti membiarkan subyek terkena pajanan yg
dicurigai atau dianggap dpt merugikan subyek