Wacholder III
Wacholder III
Wacholder III
9
Copyright © 1992 by The Johns Hopkins University School of Hygiene and Public Health Printed in U.S.A
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Several design options available in the planning stage of case-control studies are
is identified. Approximate frequency match- The other main form of overmatching can
ing can begin immediately; it uses the antic- reduce the efficiency of a study by restricting
ipated, rather than the actual, case distribu- the variability of an exposure that is corre-
tion and thereby allows the control selection lated with the exposure under study (16).
process to operate independently of the case This form of "overmatching" can occur even
selection process. However, if some of the when matching per se was not used in the
matching strata are extremely small, approx- selection of controls, as when an overly ho-
imate frequency matching can be wasteful mogeneous base is used for the study.
(II), since the control/case ratio will vary. Miettinen and Cook (17) note that the use
Probability matching (12) defines strata of a variable indicating the presence of yel-
based on the matching variables. A random low fingers, presumed to be related to smok-
studies may have a different exposure distri- case-control study or case-control within a
bution from those who do participate. Re- cohort study (19, 25, 26). This design para-
placing refusers will not increase the validity digmatically satisfies the study base principle
of a study, since refusers will still be ex- since the base is the cohort as it moves
cluded. through time. Typically, for each case, a set
The situation is different when informa- of controls is selected from subjects at risk
tion on the primary exposure, perhaps ob- at the time of disease occurrence of the case.
tained from medical records, is available, The matching in the design allows for tight
but some information on a confounder (per- control of the confounding effects of time in
haps obtained by interview) is not. Then, the analysis. Thus, this design is useful when
the impact of excluding the control is prob- close matching on time is required, as in
requiring all exposure and confounder mea- subject's level of the first-stage variable (12,
surements for all subjects; sometimes a sub- 13).
stantial reduction in expense can be A two-stage approach can be more effi-
achieved with little loss in statistical effi- cient than matching for estimating the main
ciency compared with the study with infor- effects of exposures and interactions (37)
mation on all subjects. In these designs, first- and allows for estimation of the effects of
stage variables, i.e., exposure or confounder first-stage variables, in contrast to standard
measurements that are relatively easy to ob- matched studies (13). However, any
tain, are gathered for all subjects. The re- matched study can be viewed and analyzed
maining, second-stage variables are obtained as a special case of the two-stage study, if
on only a subset of subjects, with the sam- information on the matching factor is re-
in the choice of control group, one must also prevalence would be less likely to cause bias
be concerned about choosing controls with (49, 50). Similarly, matching on calendar
conditions possibly related to exposure (2, time should be considered, if it can ensure
41,42). that exposure measurements are comparable
Unfortunately, the literature on the with respect to time, as in case-control stud-
question of differential recall for cases and ies performed in an occupational setting,
controls is sparse, and the interpretation of where industrial hygiene data from different
the published studies is difficult (43). Most years may be affected by changes in the
recent empiric research suggests that differ- quality of the measuring instruments.
ential accuracy does not cause serious dis-
tortion (40, 44-48). Empiric work on the
DISCUSSION
low response rate, particularly when nonre- 13. Weinberg CR, Wacholder S. The design and analy-
sponse might depend on exposure level, may sis of case-control studies with biased sampling.
Biometrics 1990;46:963-75.
violate the study-base principle and threaten 14. Cole P. Introduction. In: Breslow NE, Day NE,
a study's validity. eds. Statistical methods in cancer research. Vol 1.
The "ideal" (53) control group rarely ex- The analysis of case-control studies. Lyon: Inter-
national Agency for Research on Cancer, 1980:14—
ists in epidemiologic studies. Besides addi- 40. (IARC scientific publication no. 32).
tional theoretical work, empiric studies are 15. Breslow N. Design and analysis of case-control
needed to measure the impact of violations studies. Annu Rev Public Health 1982,3:29-54.
16. Day NE, Byar DP, Green SB. Overadjustment in
of the principles so intelligent trade-offs can case-control studies. Am J Epidemiol 1980; 112:
be made when planning a study. We believe, 696-706.
however, that although proper control selec- 17. Miettinen OS, Cook EF. Confounding: essence and
35. Miettinen OS. Design options in epidemiologic al. A dental x-ray validation study: comparison of
research: an update. Scand J Work Environ Health information from patient interviews and dental
1982;8(suppl 1):7-14. charts. Am J Epidemiol 1985;121:43O-9.
36. White JE. A two stage design for the study of the 45. Mackenzie SG, Lippman A. An investigation of
relationship between a rare exposure and a rare report bias in a case-control study of pregnancy
disease. Am J Epidemiol 1982; 115:119-28. outcome. Am J Epidemiol 1989; 129:65-75.
37. Breslow NE, Cain K.C. Logistic regression for two- 46. Linet MS, Van Natta ML, Brookmeyer R, et al.
stage case-control data. Biometrika 1988,75: Familial cancer history and chronic lymphocytic
11-20. leukemia: a case-control study. Am J Epidemiol
38. Cain K.C, Breslow NE. Logistic regression analysis 1989; 130:655-64.
and efficient design for two-stage studies. Am J 47. Drews CD, Kraus JF, Greenland S. Recall bias in
Epidemiol 1988; 128:1198-1206. a case-control study of sudden infant death syn-
39. Graubard B, Fears TR, Gail MH. Effects of cluster drome. Int J Epidemiol 1990; 19:405-11.
sampling on epidemiologic analysis in population- 48. Friedenreich CM, Howe GR, Miller AB. An inves-