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Biostatistics Advance Access published online on May 25, 2005
Biostatistics, 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.
Received September 24, 2004
Revised May 9, 2005
Accepted May 23, 2005

Article

Analysis of a potential trigger of an acute illness

Niels G. Becker 1*, Agus Salim 1, and Christopher W. Kelman 1

1 National Centre for Epidemiology and Population Health, Australian National University, Canberra ACT 0200, Australia

* To whom correspondence should be addressed.
Niels G. Becker, E-mail: Niels.Becker{at}anu.edu.au


  Abstract

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, when it does, a random delay until 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 hospitalisation 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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