16 Odds Ratios [from case-control studies].ppt

16: Odds Ratios [from case-control studies] Case-control studies get around several limitations of cohort studies Cohort Studies (Prior Chapter) Use incidences to assess risk Exposed cohort ? incidence1 Non-exposed cohort ? incidence0 Compare incidences via risk ratio (?) Hindrances in Cohort Studies Long induction between exposure disease may cause delays Study of rare diseases require large sample sizes to accrue sufficient numbers When studying many people ? information by necessity can be limited in scope accuracy Case-control studies were developed to help overcome some of these limitations Levin et al. (1950) Historically important study (not in Reader) Selection criteria 236 lung cancer cases -- 156 (66%) smoked 481 non-cancerous conditions (“controls”) -- 212 (44%) smoked Although incidences of lung cancer cannot be determined from data, we see an association between smoking and lung cancer How do we quantify risk from case-control data? Two article shed light on this question Cornfield, 1951 Cornfield, J. (1951). A method of estimating comparative rates from clinical data. Application to cancer of the lung, breast, and cervix. Journal of the National Cancer Institute, 11, 1269-1275. Miettinen, 1976 Miettinen, O. (1976). Estimability and estimation in case-referent studies. American Journal of Epidemiology, 103, 226-235. Cornfield, 1951 Justified use of odds ratio as estimate of relative risk Recognized potential bias in selection of cases and controls Miettinen, 1976 Conceptualized case-control study as nested in a population all population cases studied sample of population non-cases studied Miettinen (1976) Density Sampling Imagine 5 people followed over time At time t1 (shaded), D occurs in person 1 You select at random a non-cases at this time How incidence density sampling works The ratio of exposed to non-exposed time in the controls estimates the ratio of exposed to non-exposed controls in the population(see EKS for details) Data Analysis