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The exposure odds ratio in nested case-control studies with competing risks.

W D Flanders, W C Louv

    American Journal of Epidemiology
    |October 1, 1986
    PubMed
    Summary
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    Competing risks can distort results in nested case-control studies, a type of cohort study. This research provides formulas to quantify this bias, crucial for accurate epidemiological research.

    Area of Science:

    • Epidemiology
    • Biostatistics

    Background:

    • Nested case-control studies are valuable epidemiological tools.
    • Bias from competing risks is a known issue in follow-up studies but less recognized in nested designs.

    Purpose of the Study:

    • To extend understanding of bias caused by competing risks in nested case-control studies.
    • To quantify the distorting effect of competing risks on the odds ratio.

    Main Methods:

    • The study analyzes bias in nested case-control studies under a proportional hazards model.
    • Formulas for odds ratio bias were derived, considering competing risks.
    • Bias was illustrated for three distinct control selection methods.

    Main Results:

    • Competing risks can significantly bias results in nested case-control studies.

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  • The magnitude of bias depends on the association between exposure and competing risks (e.g., death, withdrawal).

    • Conclusions:

    • The impact of competing risks must be carefully considered in nested case-control study design and analysis.
    • Ignoring competing risks can lead to inaccurate effect estimates in epidemiological research.