Methodology Series Module 1: Cohort Studies

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Abstract

Cohort design is a type of nonexperimental or observational study design. In a cohort study, the participants do not have the outcome of interest to begin with. They are selected based on the exposure status of the individual. They are then followed over time to evaluate for the occurrence of the outcome of interest. Some examples of cohort studies are (1) Framingham Cohort study, (2) Swiss HIV Cohort study, and (3) The Danish Cohort study of psoriasis and depression. These studies may be prospective, retrospective, or a combination of both of these types. Since at the time of entry into the cohort study, the individuals do not have outcome, the temporality between exposure and outcome is well defined in a cohort design. If the exposure is rare, then a cohort design is an efficient method to study the relation between exposure and outcomes. A retrospective cohort study can be completed fast and is relatively inexpensive compared with a prospective cohort study. Follow-up of the study participants is very important in a cohort study, and losses are an important source of bias in these types of studies. These studies are used to estimate the cumulative incidence and incidence rate. One of the main strengths of a cohort study is the longitudinal nature of the data. Some of the variables in the data will be time-varying and some may be time independent. Thus, advanced modeling techniques (such as fixed and random effects models) are useful in analysis of these studies.

Keywords: Cohort studies, limitations, strengths

Introduction

Cohort studies are important in research design. The term “cohort” is derived from the Latin word “Cohors” – “a group of soldiers.” It is a type of nonexperimental or observational study design. The term “cohort” refers to a group of people who have been included in a study by an event that is based on the definition decided by the researcher. For example, a cohort of people born in Mumbai in the year 1980. This will be called a “birth cohort.” Another example of the cohort will be people who smoke. Some other terms which may be used for these studies are “prospective studies” or “longitudinal studies.”

Design

In a cohort study, the participants do not have the outcome of interest to begin with. They are selected based on the exposure status of the individual. Thus, some of the participants may have the exposure and others do not have the exposure at the time of initiation of the study. They are then followed over time to evaluate for the occurrence of the outcome of interest.

As seen in Figure 1 , at baseline, some of the study participants have exposure (defined as exposed) and others do not have the exposure (defined as unexposed). Over the period of follow-up, some of the exposed individuals will develop the outcome and some unexposed individuals will develop the outcome of interest. We will compare the outcomes in these two groups.