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STUDI KASUS
KONTROL/KOHORT
Aria Kekalih
Departemen Ilmu Kedokteran Komunitas
Fakultas Kedokteran Universitas Indonesia
CIRI ST KASUS KONTROL
◼ Desain observasional analitik
◼ Statistik efisien murah dibdgk st.kohort
◼ Dua jenis kelompok kel.kasus dan
kontrol
◼ Basis lapangan dan basis rumah sakit
◼ matching utk elim. Efek perancu
◼ Hasil akhir Odd Rasio
KEUNTUNGAN/KEKUATAN
◼ BANYAK INFORMASI UNTUK KASUS
◼ KASUS YANG LANGKA
◼ KASUS YANG NASA LATENT PANJANG
◼ FAKTOR RISIKO LAIN PADA KASUS
◼ REKRUTMEN RELATIF MUDAH
◼ MURAH DAN JANGKA WAKTU PENDEK
◼ OR adalah estimasi RR
KERUGIAN/KETERBATASAN
◼ INFORMASI HANYA TERBATAS KASUS
◼ BUKAN STUDI INSIDENS ATAU
PREVALENSI
◼ KELEMAHAN UTAMA BIAS ; BIAS
SELEKSI DAN PENGUKURAN
STRUKTUR
◼ the past the present
+ pop.diseas
Risk fact. cases
-
+
Risk fac. controls
- pop no diseas
CONTOH
◼ Pabrik semen , 50 karyawan gangguan
fungsi paru
◼ Jumlah karyawan 200 karyawan high
exposed
◼ > =5 thn
Pertanyaan penelitian
◼ Faktor penyebab
◼ Faktor risiko
◼ Gangguan fungsi paru dan debu semen
Kerangka konsep
◼ DV = GANGGUAN FUNGSI PARU
◼ IV = UMUR, LAMA KERJA, LAMA
TERPAJAN, RIW PENYAKIT
◼ SURVEI LINGKUNGAN : KADAR DEBU
SEMEN
BESAR SAMPEL
( p0q0 +p1q1) (z1-α)(z1-β)²
n1=n2 = -------------------------------------
( p1-p0)²
p0 = prop.kasus pada kel.kontrol
p1 = prop.kasus pada kel.kasus
Z 1- α = 1.96 ; z 1-β = 0.84
n1=n2 = 20.47 = 21 ( sampel minimum )
Kohort
Gangguan Fungsi Paru
Yes No
Pajanan
Debu
Tinggi P1 = 200 500
Rendah P2 = 100 500
Keseluruhan 300 1000
Kasus Kontrol
Gangguan Fungsi Paru
Yes No Keseluruhan
Pajanan
Debu
Tinggi P1 = 200 P2 = 100 300
Rendah
500 500 1000
Kasus Kontrol
Gangguan Fungsi Paru
Yes No Keseluruhan
Pajanan
Debu
Tinggi P1 = 200 P2 = 100 300
Rendah 300 400
500 500 1000
OR = (200/100) / (300/400)
= 2,66
Rekrutmen subjek
◼ Kelompok studi = kel.kasus = 50
◼ Kelompok kontrol = bukan kasus dapat
acak atau matching 50
subjek
- Bersedia mengikuti penelitian
ANALISIS STATISTIK
ODD RATIO (OR)
DV ( gang. f paru )
+ -
◼ IV (Lama kerj.------------------------------
>=5 thn 50(a) 10(b) 60
< 5 thn 10© 50(d) 60
-----------------------------------------
60 60 120
ANALISIS ST (2)
◼ OR = ad/bc = 50 x 50 : 10 x 10 = 25
◼ Confidence Interval (CI)+/- 95% ( 12.3
– 33.9 )
Bermakna tidak melalui angka 1
= OR bermakna :
Odd Ratio
◼ OR < 1 – hubungan protektif
◼ OR = 1 tidak ada hubungan
◼ OR > 1 = hubungan risiko
◼ OR = 2 = HUBUNGAN RISIKO
◼ OR = 5 Hubungan risiko berarti
◼ Dihubungkan dengan Kriteria Hill
Confidence Interval
◼ Dapat dihitung
◼ CI = OR pangkat ( 1 ± z √χ2 )
◼ Bila CI tidak melalui angka 1 hubungan
bermakna
ARTI OR BERMAKNA
◼ KARYAWAN YANG BEKERJA >=5 THN
BERISIKO 25 KALI MENDAPATKAN
GANGGUAN F.PARU DIBANDINGKAN
DENGAN KARYAWAN YANG BERKERJA
< 5 THN
ATRIBUTABLE RISK
◼ DIHUBUNGKAN DENGAN DAMPAK PADA
KESMAS
◼ AR = Ie – In
◼ Ie = proporsi kasus kelompok pajanan
tinggi
◼ In = proporsi kasus kelompok pajanan
rendah
◼ 1. Buat contoh pertanyaan
penelitian yang sesuai dengan
desain kasus control
◼ 2. Tentukan variable bebas dan
tergantung
◼ 3. buatlah hipotesis
Studi kohort
◼ 1. observasional analitik
◼ 2. pembentukan kel berdasarkan
terpajan = kel studi dan tidak terpajan
= kel.kontrol
◼ 3. kel studi dan kontrol diikuti sampai
terjadi outcome yg diteliti
◼ 4. prospektif dan retrospektif
Keuntungan/kekuatan
◼ Pengob.pada org yg diinginkan
◼ Prospektif ada kontrol pengump.data
◼ Sejarah perkemb.penyakit
◼ Manuv.lain terkontrol pada prospektif
◼ Prospektif dapat matching
◼ Masalah kes sehari-hari
◼ Studi insidnsi
Kerugian /keterbatasan
◼ Faktor perancu
◼ Analisis statistik rumit
◼ Mahal dan lama
Jenis kohort
◼ Prospektif
◼ Retrospektif
◼ Nested case control
◼ Prognostik
◼ Multiple/double cohort
struktur
present future
+
risk fact disease
-
+
risk fact disease
-
CONTOH
-
◼ Masyarakat pinggiran sungai Ciliwung
◼ Pabrik aki
◼ Cd / kelainan /gangguan ginjal
langkah
◼ Kerangka konsep
◼ Populasi/subjek
◼ Kerangka sampel
◼ Besar sampel
◼ Rekrutmen subjek
Sampling
◼ Random /
Probability
◼ Simple
◼ Sistematis
◼ Stratifikasi
◼ Cluster
◼ Proportional
◼ Non Random /
Non Probability
◼ Konsekutif
◼ Purposive
◼ Convenient
ANALISIS STATISTIK
◼ RELATIVE RISK
◼ CONFIDENCE INTERVAL
◼ ATTRIBUTABLE RISK
◼ IDR
◼ LOGISTIC REGRESSION FUNCTION
◼ SURVIVAL ANALISIS
Kesimpulan
Terima kasih

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04 Desain Penelitian Case Control dan membedakannya dengan Kohort.pdf

  • 1. STUDI KASUS KONTROL/KOHORT Aria Kekalih Departemen Ilmu Kedokteran Komunitas Fakultas Kedokteran Universitas Indonesia
  • 2. CIRI ST KASUS KONTROL ◼ Desain observasional analitik ◼ Statistik efisien murah dibdgk st.kohort ◼ Dua jenis kelompok kel.kasus dan kontrol ◼ Basis lapangan dan basis rumah sakit ◼ matching utk elim. Efek perancu ◼ Hasil akhir Odd Rasio
  • 3.
  • 4. KEUNTUNGAN/KEKUATAN ◼ BANYAK INFORMASI UNTUK KASUS ◼ KASUS YANG LANGKA ◼ KASUS YANG NASA LATENT PANJANG ◼ FAKTOR RISIKO LAIN PADA KASUS ◼ REKRUTMEN RELATIF MUDAH ◼ MURAH DAN JANGKA WAKTU PENDEK ◼ OR adalah estimasi RR
  • 5. KERUGIAN/KETERBATASAN ◼ INFORMASI HANYA TERBATAS KASUS ◼ BUKAN STUDI INSIDENS ATAU PREVALENSI ◼ KELEMAHAN UTAMA BIAS ; BIAS SELEKSI DAN PENGUKURAN
  • 6. STRUKTUR ◼ the past the present + pop.diseas Risk fact. cases - + Risk fac. controls - pop no diseas
  • 7. CONTOH ◼ Pabrik semen , 50 karyawan gangguan fungsi paru ◼ Jumlah karyawan 200 karyawan high exposed ◼ > =5 thn
  • 8. Pertanyaan penelitian ◼ Faktor penyebab ◼ Faktor risiko ◼ Gangguan fungsi paru dan debu semen
  • 9. Kerangka konsep ◼ DV = GANGGUAN FUNGSI PARU ◼ IV = UMUR, LAMA KERJA, LAMA TERPAJAN, RIW PENYAKIT ◼ SURVEI LINGKUNGAN : KADAR DEBU SEMEN
  • 10.
  • 11. BESAR SAMPEL ( p0q0 +p1q1) (z1-α)(z1-β)² n1=n2 = ------------------------------------- ( p1-p0)² p0 = prop.kasus pada kel.kontrol p1 = prop.kasus pada kel.kasus Z 1- α = 1.96 ; z 1-β = 0.84 n1=n2 = 20.47 = 21 ( sampel minimum )
  • 12. Kohort Gangguan Fungsi Paru Yes No Pajanan Debu Tinggi P1 = 200 500 Rendah P2 = 100 500 Keseluruhan 300 1000
  • 13. Kasus Kontrol Gangguan Fungsi Paru Yes No Keseluruhan Pajanan Debu Tinggi P1 = 200 P2 = 100 300 Rendah 500 500 1000
  • 14. Kasus Kontrol Gangguan Fungsi Paru Yes No Keseluruhan Pajanan Debu Tinggi P1 = 200 P2 = 100 300 Rendah 300 400 500 500 1000 OR = (200/100) / (300/400) = 2,66
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
  • 20. Rekrutmen subjek ◼ Kelompok studi = kel.kasus = 50 ◼ Kelompok kontrol = bukan kasus dapat acak atau matching 50 subjek - Bersedia mengikuti penelitian
  • 21. ANALISIS STATISTIK ODD RATIO (OR) DV ( gang. f paru ) + - ◼ IV (Lama kerj.------------------------------ >=5 thn 50(a) 10(b) 60 < 5 thn 10© 50(d) 60 ----------------------------------------- 60 60 120
  • 22. ANALISIS ST (2) ◼ OR = ad/bc = 50 x 50 : 10 x 10 = 25 ◼ Confidence Interval (CI)+/- 95% ( 12.3 – 33.9 ) Bermakna tidak melalui angka 1 = OR bermakna :
  • 23. Odd Ratio ◼ OR < 1 – hubungan protektif ◼ OR = 1 tidak ada hubungan ◼ OR > 1 = hubungan risiko ◼ OR = 2 = HUBUNGAN RISIKO ◼ OR = 5 Hubungan risiko berarti ◼ Dihubungkan dengan Kriteria Hill
  • 24. Confidence Interval ◼ Dapat dihitung ◼ CI = OR pangkat ( 1 ± z √χ2 ) ◼ Bila CI tidak melalui angka 1 hubungan bermakna
  • 25. ARTI OR BERMAKNA ◼ KARYAWAN YANG BEKERJA >=5 THN BERISIKO 25 KALI MENDAPATKAN GANGGUAN F.PARU DIBANDINGKAN DENGAN KARYAWAN YANG BERKERJA < 5 THN
  • 26. ATRIBUTABLE RISK ◼ DIHUBUNGKAN DENGAN DAMPAK PADA KESMAS ◼ AR = Ie – In ◼ Ie = proporsi kasus kelompok pajanan tinggi ◼ In = proporsi kasus kelompok pajanan rendah
  • 27. ◼ 1. Buat contoh pertanyaan penelitian yang sesuai dengan desain kasus control ◼ 2. Tentukan variable bebas dan tergantung ◼ 3. buatlah hipotesis
  • 28. Studi kohort ◼ 1. observasional analitik ◼ 2. pembentukan kel berdasarkan terpajan = kel studi dan tidak terpajan = kel.kontrol ◼ 3. kel studi dan kontrol diikuti sampai terjadi outcome yg diteliti ◼ 4. prospektif dan retrospektif
  • 29.
  • 30. Keuntungan/kekuatan ◼ Pengob.pada org yg diinginkan ◼ Prospektif ada kontrol pengump.data ◼ Sejarah perkemb.penyakit ◼ Manuv.lain terkontrol pada prospektif ◼ Prospektif dapat matching ◼ Masalah kes sehari-hari ◼ Studi insidnsi
  • 31.
  • 32. Kerugian /keterbatasan ◼ Faktor perancu ◼ Analisis statistik rumit ◼ Mahal dan lama
  • 33. Jenis kohort ◼ Prospektif ◼ Retrospektif ◼ Nested case control ◼ Prognostik ◼ Multiple/double cohort
  • 34. struktur present future + risk fact disease - + risk fact disease -
  • 35. CONTOH - ◼ Masyarakat pinggiran sungai Ciliwung ◼ Pabrik aki ◼ Cd / kelainan /gangguan ginjal
  • 36. langkah ◼ Kerangka konsep ◼ Populasi/subjek ◼ Kerangka sampel ◼ Besar sampel ◼ Rekrutmen subjek
  • 37. Sampling ◼ Random / Probability ◼ Simple ◼ Sistematis ◼ Stratifikasi ◼ Cluster ◼ Proportional ◼ Non Random / Non Probability ◼ Konsekutif ◼ Purposive ◼ Convenient
  • 38.
  • 39. ANALISIS STATISTIK ◼ RELATIVE RISK ◼ CONFIDENCE INTERVAL ◼ ATTRIBUTABLE RISK ◼ IDR ◼ LOGISTIC REGRESSION FUNCTION ◼ SURVIVAL ANALISIS
  • 40.
  • 41.