Biostatistics Advance Access originally published online on May 14, 2008
Biostatistics 2009 10(1):17-31; doi:10.1093/biostatistics/kxn010
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Adjusting for selection bias in retrospective, case–control studies
Department of Epidemiology and Public Health, Imperial College School of Medicine, London, UK s.geneletti{at}imperial.ac.uk
* To whom correspondence should be addressed.
Retrospective case–control studies are more susceptible to selection bias than other epidemiologic studies as by design they require that both cases and controls are representative of the same population. However, as cases and control recruitment processes are often different, it is not always obvious that the necessary exchangeability conditions hold. Selection bias typically arises when the selection criteria are associated with the risk factor under investigation. We develop a method which produces bias-adjusted estimates for the odds ratio. Our method hinges on 2 conditions. The first is that a variable that separates the risk factor from the selection criteria can be identified. This is termed the "bias breaking" variable. The second condition is that data can be found such that a bias-corrected estimate of the distribution of the bias breaking variable can be obtained. We show by means of a set of examples that such bias breaking variables are not uncommon in epidemiologic settings. We demonstrate using simulations that the estimates of the odds ratios produced by our method are consistently closer to the true odds ratio than standard odds ratio estimates using logistic regression. Further, by applying it to a case–control study, we show that our method can help to determine whether selection bias is present and thus confirm the validity of study conclusions when no evidence of selection bias can be found.
Keywords: Conditional independence; Confounding; Directed acyclic graphs; Post-stratification; Retrospective case–control studies; Selection bias; Weighting
Received June 29, 2007; revised December 14, 2007; revised January 22, 2008; revised February 20, 2008; accepted for publication March 21, 2008.
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