Case-Control Studies

  • Bryan Kestenbaum


  1. 7.1
    Case-control studies are observational studies that are conducted in three basic steps:
    1. 7.1.1

      Identify people who have a specific disease or condition

    2. 7.1.2

      Identify a comparison group of people who do not have this condition

    3. 7.1.3

      Determine the proportion of each group who had a previous exposure

  2. 7.2
    To increase the chance of obtaining valid associations in case-control studies:
    1. 7.2.1

      Cases should be selected using a specific definition of the disease.

    2. 7.2.2

      Controls should be selected from the same underlying population as the cases.

    3. 7.2.3

      Nested case control studies select cases and controls from a unified population.

    4. 7.2.4

      Matching may be performed to increase similarity between cases and controls.

    5. 7.2.5

      A steep increase in study power is achieved until about 3–4 controls per case.

  3. 7.3
    Analysis of case-control data
    1. 7.3.1

      The odds ratio is the primary measure of association in case-control studies.

    2. 7.3.2

      Odds ratios approximate relative risks when the disease outcome is rare.

  4. 7.4
    Advantages of case-control studies include:
    1. 7.4.1

      Useful for studying rare diseases

    2. 7.4.2

      Can efficiently determine associations using relatively few study participants

    3. 7.4.3

      Can evaluate multiple risk factors for a disease outcome

  5. 7.5
    Limitations of case-control studies include:
    1. 7.5.1

      Confounding characteristics other than the exposure of interest may bias observed associations with disease

    2. 7.5.2

      Valid measurements of previous exposures must be obtained in retrospect

    3. 7.5.3

      Study design prohibits direct calculation of the incidence of disease



  1. 1.
    Smeeth L, Cook C, Fombonne E, et al. MMR vaccination and pervasive developmental disorders: a case-control study. Lancet. 2004;364(9438):963–9.CrossRefGoogle Scholar
  2. 2.
    Sulheim S, Holme I, Ekeland A, Bahr R. Helmet use and risk of head injuries in alpine skiers and snowboarders. JAMA. 2006;295(8):919–24.CrossRefGoogle Scholar
  3. 3.
    Habibi M, Chahal H, Opdahl A, et al. Association of CMR-measured LA function with heart failure development: results from the MESA study. JACC Cardiovasc Imaging. 2014;7(6):570–9.CrossRefGoogle Scholar
  4. 4.
    Papadakis MA, Teherani A, Banach MA, et al. Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med. 2005;353(25):2673–82.CrossRefGoogle Scholar
  5. 5.
    English PB, Goldberg DE, Wolff C, Smith D. Parental and birth characteristics in relation to testicular cancer risk among males born between 1960 and 1995 in California (United States). Cancer Causes Control. 2003;14(9):815–25.CrossRefGoogle Scholar
  6. 6.
    Hogan SL, Cooper GS, Savitz DA, et al. Association of silica exposure with anti-neutrophil cytoplasmic autoantibody small-vessel vasculitis: a population-based, case-control study. Clin J Am Soc Nephrol. 2007;2(2):290–9.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Bryan Kestenbaum
    • 1
  1. 1.Division of Nephrology, Department of MedicineUniversity of WashingtonSeattleUSA

Personalised recommendations