Cohort studies: marching towards outcomes.

A cohort study tracks two or more groups forward from exposure to outcome. This type of study can be done by going ahead in time from the present (prospective cohort study) or, alternatively, by going back in time to comprise the cohorts and following them up to the present (retrospective cohort study). A cohort study is the best way to identify incidence and natural history of a disease, and can be used to examine multiple outcomes after a single exposure. However, this type of study is less useful for examination of rare events or those that take a long time to develop. A cohort study should provide specific definitions of exposures and outcomes: determination of both should be as objective as possible. The control group (unexposed) should be similar in all important respects to the exposed, with the exception of not having the exposure. Observational studies, however, rarely achieve such a degree of similarity, so investigators need to measure and control for confounding factors. Reduction of loss to follow-up over time is a challenge, since differential losses to follow-up introduce bias. Variations on the cohort theme include the before-after study and nested case-control study (within a cohort study). Strengths of a cohort study include the ability to calculate incidence rates, relative risks, and 95% CIs. This format is the preferred way of presenting study results, rather that with p values.