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Cross-sectional studies (also known as cross-sectional analyses, transversal studies, prevalence study) are one type of observational study that involves data collection from a population, or a representative subset, at one specific point in time. They differ from case-control studies in that they aim to provide data on the entire population under study, whereas case-control studies typically include only individuals with a specific characteristic, with a sample, often a tiny minority, of the rest of the population. Cross-sectional studies are descriptive studies (neither longitudinal nor experimental). Unlike case-control studies, they can be used to describe, not only the odds ratio, but also absolute risks and relative risks from prevalences (sometimes called prevalence risk ratio, or PRR). They may be used to describe some feature of the population, such as prevalence of an illness, or they may support inferences of cause and effect. Longitudinal studies differ from both in making a series of observations more than once on members of the study population over a period of time.
Cross-sectional studies in healthcare
Cross-sectional studies involve data collected at a defined time. They are often used to assess the prevalence of acute or chronic conditions, or to answer questions about the causes of disease or the results of intervention. They may also be described as censuses. Cross-sectional studies may involve special data collection, including questions about the past, but they often rely on data originally collected for other purposes. They are moderately expensive, and are not suitable for the study of rare diseases. Difficulty in recalling past events may also contribute bias.
Use of routine data: large scale, low cost to the researcher
The use of routinely collected data allows large cross-sectional studies to be made at little or no expense. This is a major advantage over other forms of epidemiological study. A natural progression has been suggested from cheap cross-sectional studies of routinely collected data which suggest hypotheses, to case-control studies testing them more specifically, then to cohort studies and trials which cost much more and take much longer, but may give stronger evidence. In a cross-sectional survey, a specific group is looked at to see if an activity, say alcohol consumption, is related to the health effect being investigated, say cirrhosis of the liver. If alcohol use is correlated with cirrhosis of the liver, this would support the hypothesis that alcohol use may cause cirrhosis.
Routine data not designed to answer the specific question
However, routinely collected data does not normally describe which variable is the cause and which the effect. Cross-sectional studies using data originally collected for other purposes are often unable to include data on confounding factors, other variables that affect the relationship between the putative cause and effect. For example, data only on present alcohol consumption and cirrhosis would not allow the role of past alcohol consumption, or of other causes, to be explored.
Most case-control studies collect specifically designed data on all participants, including data fields designed to allow the hypothesis of interest to be tested. However, in issues where strong personal feelings may be involved, specific questions may be a source of bias. For example, past alcohol consumption may be incorrectly reported by an individual wishing to reduce their personal feelings of guilt. Such bias may be less in routinely collected statistics, or effectively eliminated if the observations are made by third parties, for example taxation records of alcohol by area.
Aggregated data and the "ecological fallacy"
Cross-sectional studies can contain individual-level data (one record per individual, for example, in national health surveys). However, in modern epidemiology it may be impossible to survey the entire population of interest, so cross-sectional studies often involve secondary analysis of data collected for another purpose. In many such cases, no individual records are available to the researcher, and group-level information must be used. Major sources of such data are often large institutions like the Census Bureau or the Centers for Disease Control in the United States. Recent census data is not provided on individuals — in the UK individual census data is released only after a century. Instead data are aggregated, usually by administrative area. Inferences about individuals based on aggregate data are weakened by the ecological fallacy. Also consider the potential for committing the "atomistic fallacy" where assumptions about aggregated counts are made based on the aggregation of individual level data (such as averaging census tracts to calculate a county average). For example, it might be true that there is no correlation between infant mortality and family income at the city level, while still being true that there is a strong relationship between infant mortality and family income at the individual level. All aggregate statistics are subject to compositional effects, so that what matters is not only the individual-level relationship between income and infant mortality, but also the proportions of low, middle, and high income individuals in each city. Because case-control studies are usually based on individual-level data, they do not have this problem.
- Schmidt, CO; Kohlmann, T (2008). "When to use the odds ratio or the relative risk?". International journal of public health 53 (3): 165–167. doi:10.1007/s000-00-7068-3. PMID 19127890.
- Lee, James (1994). "Odds Ratio or Relative Risk for Cross-Sectional Data?". International Journal of Epidemiology 23 (1): 201–3. doi:10.1093/ije/23.1.201. PMID 8194918.
- Epidemiology for the Uninitiated by Coggon, Rose, and Barker, Chapter 8, "Case-control and cross-sectional studies", BMJ (British Medical Journal) Publishing, 1997
- Research Methods Knowledge Base by William M. K. Trochim, Web Center for Social Research Methods, copyright 2006
- Cross-Sectional Design by Michelle A. Saint-Germain
- Study Design Tutorial Cornell University College of Veterinary Medicine