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What is the "golden standard" for assessing population-based interventions?--problems of dilution bias
1Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Objectives:
To identify different types of dilution bias in population-based interventions and to suggest measures for handling these methodological problems.
Design:
Literature review plus analysis of data from a population-based intervention against cardiovascular disease in a Swedish municipality.
Main Results:
The effects of an intervention on mortality and morbidity were much more diluted by non-intervening factors, dissemination to areas outside the intervention area, social diffusion, population mobility and time than by using intermediate outcome measures.
Conclusions:
Theoretically, changes in scientifically well documented risk factors, for example, intermediate outcome measures, should be preferred to using morbidity or mortality as outcome measures.
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