In epidemiology, a cross-sectional study measuring both exposure and disease simultaneously is most susceptible to which type of problem?

• A Loss to follow-up
• B Regression to the mean
• C Volunteer bias in long-term studies
• D Inability to establish temporal relationship between exposure and outcome ✓

Explanation

The fundamental limitation of cross-sectional studies is that exposure and disease are measured simultaneously; therefore, it is impossible to determine which came first — the exposure or the disease. This means cross-sectional studies cannot establish temporality, a prerequisite for causation. They are prone to prevalence-incidence (Neyman) bias and are best suited for establishing prevalence and generating hypotheses. Loss to follow-up is a limitation of cohort/longitudinal studies.

Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.

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