Professional Documents
Culture Documents
Epidemiological Studies
K Rothman
Definition of bias
• What is null?
Selection bias
Cases Controls A
liver cirrhosis trauma ward
OR=6
OR=6 OR=36
Diagnostic bias
Diagnostic approach related to knowing exposure status
Cases
Controls
uterine cancer
Takes oral
a b
contraceptives
Had test c d
lung cancer
yes no
Smoker 9 91 100
Non-smoker 1 99 100
9 1
RR 9
100 100
lung cancer
yes no
Sportive smoker* 0 7 7
Unhealthy smoker 9 51 60
Non-smoker 1 99 100
9 1
RR 13.4
67 100
Loss to follow-up
lost to follow-up
lower disease rate among exposed (=migrant)
Minimising selection bias
• Clear definition of study population
• Explicit case and control definitions
• Cases and controls from same population
• Selection of exposed and non-exposed without
knowing disease status (retrospective cohort)
Information bias
Non-differential Differential
• Random error • Systematic error
• Unrelated to exposure or • Related to exposure or
outcome status outcome status
• Not a bias • Bias
• Weakens measure of • Measure of association
association distorted in any direction
Two main types of information bias
• Reporting bias
- Recall bias
• Observer bias
- Interviewer bias
- Biased follow-up
Recall bias
Cases remember exposure differently than controls
Mothers of
Children with
Controls
malformation
Took tobacco,
a b
alcohol, drugs
Cases of
Controls
listeriosis
• Example
- Cohort study to investigate risk factors for
mesothelioma
- Difficult histological diagnosis
- Histologist more likely to diagnose specimen as
mesothelioma if asbestos exposure kown
Non-differential misclassification
Incidence
No misclassification RR
per mill
• Loss to follow up
- The major source of bias in cohort studies
- Assume that all do / do not develop outcome?
• Ascertainment and interviewer bias
- Some concern: Knowing exposure may influence how
outcome determined
• Non-response, refusals
- Little concern: Bias arises only if related to both exposure
and outcome
• Recall bias
- No problem: Exposure determined at time of enrolment
Bias in retrospective cohort &
case-control studies
• Ascertainment bias, participation bias,
interviewer bias
- Exposure and disease have already occurred
differential selection / interviewing of compared
groups possible
• Recall bias
- Cases (or ill) may remember exposures differently
than controls (or healthy)
Control of bias