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Biostatistics Advance Access originally published online on May 25, 2005
Biostatistics 2006 7(1):16-28; doi:10.1093/biostatistics/kxi037
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© The Author 2005. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oupjournals.org.

Analysis of a potential trigger of an acute illness

Niels G. Becker*, Agus Salim and Christopher W. Kelman

National Centre for Epidemiology and Population Health, Australian National University Canberra ACT 0200, Australia Niels.Becker{at}anu.edu.au

* To whom correspondence should be addressed.

Sometimes certain short-term risk exposures are postulated to act as a trigger for the onset of a specific acute illness. When the incidence of the illness is low it is desirable to investigate this possible association using only data on cases detected during a specific observation period. Here we propose an analysis for such a study based on a model expressed in terms of the probability that the exposure triggers the illness and a random delay from a triggered illness until its diagnosis. Both the natural hazard rate for the illness and the probability that the exposure triggers the illness are assumed to be small and possibly dependent on age and covariates such as sex and duration or severity of the exposure. The method of analysis is illustrated with a study of the association between long flights and hospitalization for venous thromboembolism.

Keywords: Air travel; Case-crossover design; Case-only study; Deep vein thrombosis; Proportional hazards model; Pulmonary embolism; Record Linkage; Venous thromboembolism


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