Identification of cases can be made from the general population using health register and data or from a particular medical setting. The criteria for diagnosis of a case should be defined as well as the eligibility criteria used for selection. The diagostic criteria should be sensitive and specific (i.e. strict!). Information on diseases can be got from death certificates, disease registers, medical records or population survey. For rare diseases, cases may have to sought from large areas or over many years.

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1. Define a study population (source of cases and controls) 
2. Define and select cases.
3. Define and select controls.
4. Measure exposure.

Four steps in conducting a case-control study

James, G., Witten, D., Hastie, T., & Tibshirani, R. (2013). An introduction to statistical learning (Vol. 112, pp. 3-7). New York: springer.

An Introduction to Statistical Learning with Applications in R

Controls must have as similar a background as possible to the cases, except that they do not have the outcome in question. They should come from the same population as the cases. Their selection should be independent of the exposures of interest. Objective measures of the presence of risk factors are best, ideally carried out in a 'blind' assessment or before the cases and controls are identified

Define a study population

Define and select cases

This is a very important step. Get this wrong and you introduce bias into the study. Controls should represent the population that the cases come from (i.e. they should be at risk of becoming new cases). Ratio to cases is usually 1:1. If cases are limited, you can have up to 4 controls: 1 case. Some time will be needed in considering the way in which the cases and controls, which make up the study will be chosen. More heterogeneity in the cases, less likelihood of being able to link a specific risk factor to the disease causation. But, narrower the category of disease for inclusion as 'cases', less general applicability the findings will have.

Define and select controls

The measurement of the exposure(s) must be collected in a comparable way for cases and controls. It is worth 'blinding' the data gatherers to case or control status of participants or at least blind them to the main hypothesis of the study. This should help prevent measurement or researcher bias. Exposure information can come from records (though, obvious disadvantage is that records can be inaccurate, incomplete and were not originially collected for the study purposes) or can be via an interview or questionnaire (this can introduce recall bias, where cases have more vested interest in recalling the exposures than controls, and sometimes rely on 'proxy' respondents, e.g. carers, or parents of children).

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