Computation of relative risk based on simultaneous surveys: an alternative to cohort and case-control studies

If the same information on the distribution of risk factors is available for both the general population and a subset distinguished by some disease outcome, it becomes possible to derive relative risk estimates applicable to the entire population with the assurance that the data upon which the estimates are based is representative of that population. To illustrate this approach, data from the 1986 National Mortality Follow-back Survey and the 1987 National Health Interview Survey were used to compute rate ratios for several causes of death for work in dirtyier as compared with cleaner occupations by three methods commonly employed in cohort and case-control studies: the usual standardized rate ratio, the Mantel-Haenszel estimate of the rate ratio, and a multiplicative model fit to an appropriate cross-classification. Properly placed questions in appropriate surveys might very well serve as a substitute for cohort studies and could be performed at less cost and with less overall effort, and completed in a shorter time. Moreover, this approach is less subject to problems of representativeness than cohort and case-control studies.