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American Journal of Epidemiology Vol. 124, No. 4: 684-692
Copyright © 1986 by The Johns Hopkins University School of Hygiene and Public Health

research-article

THE EXPOSURE ODDS RATIO IN NESTED CASE-CONTROL STUDIES WITH COMPETING RISKS1

W. DANA FLANDERS2 and WILLIAM C. LOUV

Reprint requests to Dr. W. Dana Flanders at current address: Centers for Disease Control, 1600 Clifton Road, C-25, Atlanta, GA 30333

A nested case-control study, also known as an ambidirectional study, is a case-control study within a cohort study. Although distortion by competing risks is well-recognized in follow-up studies, the problem has not been as widely appreciated in nested case-control studies. This paper extends previous work concerning the bias associated with competing risks for nested case-control studies. Specifically, the distorting effect of competing risks is illustrated for three methods of control selection. Assuming the proportional hazards model, the authors derived formulas for the bias of the odds ratio when competing risks cannot be ignored. Examples illustrate the magnitude of bias that occurs when the exposure of interest is associated with competing causes of death or withdrawal

epidemiologic methods; risk; statistics

1From the Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.


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