实习3病例对照研究

实习3 病例对照研究

【目的】通过课题资料分析, 掌握病例对照研究的基本原理，病例对照研究常用指标的计算及资料基本整理分析方法。

【时间】6～9学时。

【内容】

第一部分病例对照研究的基本原理

【课题一】

1、Background

Many countries, especially industrialized countries, reported the annual mortality rate of lung cancer increased year by year since the 1920s. The mortality rate were 1.1/100,000 for male and 0.6/100,000 for female from 1901 to 1920, it increased to 10.6/100,000 for male and 2.5/100,000 for female from 1936-1939.

It was raised that the smoking, air pollution and other risk factors were the cause of lung cancer, but it was also pointed out that the increasing lung cancer death rate is due to human longevity, aging of population and/or the improvement of diagnostic methods for lung cancer and so on, the latter resulted in the elevation of detection rate and the level of diagnosis for lung cancer.

Question 1：To determine the relationship between lung cancer and smoking, what kind of epidemiological study should be performed? How to test the hyposis using the method? How to exclude other factors?

2、Study method

Aim at the above-mentioned problems, Doll and Hill studied the relationship between smoking and lung cancer using epidemiological methods. They collected inpatients of lung cancer from 20 hospitals in and around London (added some hospital in other cities later) as investigation subjects from April 1948 to February 1952, interviewers surveyed all the new patients of lung, stomach and colon cancer in those hospitals during those four years.

Each survey case of lung cancer matched one case of other cancer who hospitalized over the same period as control. A concise questionnaire was developed to study the cause of the disease. Both case and control were surveyed the informations of past and present in detail, filled the uniform questionnaire with the exactly same items (Table 1). Surveys were carried out by

investigators with four-year investigation experience and the investigation of control should be detailed and precise as same as case.

Question 2：Why did they investigate the gastric and colorectal cancer patients of during the same period?

Questions 3: Can the subjects represent the target population when they were sampled from inpatients of lung cancer? How to make it certain that control group was comparable to lung cancer group when we selected them among inpatients?

表1 吸烟与肺癌关系调查表

病例对照编号

姓名________性别______出生年月__________ 年龄____岁，

职业_______ 民族____ 家庭住址：__________________________________________ 何时迁来_____________年工作单位：_________________________________________

地址______________________________________________________________________

工种（职务）_________从事该工作年限_______年，工作中曾否接触过有毒有害物质：有，无；接触：①铀，②石棉尘，③放射性物质，④水泥，⑤锯末，⑥芥子气，⑦二氧化硫，⑧氯气_______________________________________________________

在何时（年），多长时间__________________________________________________

访问开始时间：_____点____分，结束时间：_____点____分，实际访问时间_______分。

对调查评论：_______________________________________________________________

调查者签名：_______________________

病史及诊断

1．曾否患肺癌：有，无，确诊时间__________年__________月

2. 曾否患其他癌症：有，无，患癌部位：___________ 确诊时间：_____年_____月

3. 确诊单位：________________ 住院日期：________年_____月，病历号___________

4. 确诊依据：①临床②X线③手术④病理

5. 诊断：__________________________ 组织类型_____________________________ 1. 曾否吸过烟：曾，否；吸烟________年现在吸烟：吸，不吸