第四章队列研究带备注教程.pptx

队列研究 Cohort Study;队列研究 Cohort study; Outline Example Design and implement Measures of Risk Data sort and analysis Bias and Control Advantage，disadvantage ;队列研究简史 定义与目的 原理与类型;历史 History;Tuberculosis (20th century) 结核（20世纪） WH Frost performed the first retrospective cohort study in a cohort of 132 homes with tuberculosis WH Frost 在有结核的132个家庭的队列开展第一个回顾性队列研究 Used person-years to estimate attack rates 用人年来估计罹患率;WH Frost initiated prospective cohort study of tuberculosis in Williamson county, Tennessee WH Frost 在德州启动有关结核的前瞻性队列研究;Framingham study of cardiovascular disease, 1948 Japanese atomic bomb survivors, 1946 British physician study, 1950s Colorado Plateau uranium miners, 1950s;Nurses Health study, 1976 to present British physician study Multi-center AIDS Cohort Study MACS, 1984 – 1999 ; An epidemiologic design in which the incidence of a disease (or condition) is compared among exposed and unexposed individuals 是比较暴露与非暴力人群发病率的一种流行病学设计 ;Cohort Study;Cohort Study;What is a cohort? 队列;暴露 指接触过某种物质、具备某种特征或处于某种状态。 危险因素 泛指能引起某特定不良结局,或使其发生的概率增加的因子，包括个人行为、生活方式、环境和遗传等多方面的因素。; 目的 Purpose;目的 Purpose;Framingham study of cardiovascular disease Individuals 30 – 62 years old in community at risk for disease Framingham, MA, 1948 to present ;Goal to elucidate the natural history of HIV/AIDS 5000 gay men, volunteers 5 cities in US 1984 – Extensive evaluations Questionnaire Physical examination Laboratory testing;Source: partially adapted from WHO, 1993;Characteristics 特点;类型 Types;类型 Types;Prospective cohort study;Prospective cohort study;Follow-up to identify outcome Question can be incidence or risk of outcome Question can be what factors associated with outcome Ascertainment of outcome done in future;Prospective Cohort Example;Example;Determine outcomes: follow-up all patients for 1 year – identify how many GI bleeds there are in each sub-cohort or exposure group ;Prospective Cohort Studies;Disadvantage: expensive and time consuming (