Control selection strategies in case-control studies of childhood diseases

To address concerns regarding the representativeness of controls in case-control studies, two selection strategies were evaluated in a study of childhood leukemia, which commenced in California in 1995. The authors selected two controls per case: one from among children identified by using computerized birth records and located successfully, the other from a roster of friends; both were matched on demographic factors. Sixty-four birth certificate-friend control pairs were enrolled (n = 128). Additionally, 192 "ideal" controls were selected without tracing from the birth records. Data on parental ages, parental education, mother's reproductive history, and birth weight were obtained from the birth certificates of all 320 subjects. For all variables except birth weight, the differences between birth certificate and ideal controls were smaller than those between friend and ideal controls. None of the differences between birth certificate and ideal controls was significant, whereas two factors were significantly different between friend and ideal controls. These findings suggest that friend controls may be less representative than birth certificate controls. Despite difficulty in tracing and a seemingly low participation rate (49.0% for 560 enrolled birth certificate controls), using birth records to recruit controls appears to provide a representative sample of children and an opportunity to assess the representativeness of controls.