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The sick person effect.

T D Sterling1, J J Weinkam, J L Weinkam

  • 1School of Computing Science, Faculty of Applied Science, Simon Fraser University, Burnaby, B.C., Canada.

Journal of Clinical Epidemiology
|January 1, 1990
PubMed
Summary

The Sick Person Effect (SPE) biases studies where participants have poorer health, unlike the known Healthy Worker Effect (HWE). This bias occurs when comparing sick individuals to the general population, impacting risk assessment validity.

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Area of Science:

  • Epidemiology
  • Biostatistics
  • Public Health

Background:

  • The Healthy Worker Effect (HWE), or Healthy Person Effect (HPE), is a known bias in epidemiological studies.
  • This bias arises when study participants are healthier than the general population due to selection criteria.
  • The converse, the Sick Person Effect (SPE), where participants are selected based on poorer health, is less understood.

Purpose of the Study:

  • To demonstrate the existence and impact of the Sick Person Effect (SPE).
  • To highlight how SPE can introduce bias in epidemiological study designs.
  • To emphasize the importance of appropriate referent selection in risk assessment.

Main Methods:

  • Study 1: Compared disease incidence in children selected for medical treatment versus their siblings.
  • Study 2: Calculated Standardized Morbidity Ratios (SmRs) for individuals reporting chronic symptoms.
  • Both studies used the general population as a referent group.

Main Results:

  • The Sick Person Effect (SPE) was evident in both studies.
  • SPE was apparent when comparing disease incidence or morbidity in selected groups against the general population.
  • This indicates a significant bias when using the general population as a referent for sicker cohorts.

Conclusions:

  • The Sick Person Effect (SPE) is a critical bias that can compromise the validity of epidemiological research.
  • Both SPE and HPE can lead to inaccurate conclusions regarding health risks.
  • Careful consideration of referent populations is crucial for accurate risk assessment in epidemiological studies.

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