American Journal of Epidemiology Vol. 127, No. 4: 851-856
Copyright © 1988 by The Johns Hopkins University School of Hygiene and Public Health
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CASE-CONTROL STUDIES USING OTHER DISEASES AS CONTROLS: PROBLEMS OF EXCLUDING EXPOSURE-RELATED DISEASES
1Department of Epidemiology, School of Public Health, University of North Carolina Chapel Hill, NC 27514
2Department of Community Health, Wellington School of Medicine, Wellington Hospital Wellington, New Zealand
Reprint requests to Dr. Neil Pearce
Exclusion criteria are examined in case-control studies which include persons with other diseases in the control group. Theoretically, a sample of the study base should not exclude persons who develop exposure-related diseases before, during, or after the time period in which the case occurred. This principle also generally applies when controls are sampled from the subset of persons with other diseases generated by the same study base. In particular, If the incidence rates (assuming completeness of ascertainment) for all other diseases combined are similar in the exposed and nonexposed populations, then controls should be sampled from all other diseases, regardless of their relation to exposure. On the other hand, If the composite incidence rate for other diseases is greater (or less) in the exposed population, then it may be necessary to exclude controls with diseases positively (or negatively) associated with exposure. Additionally, considerable care should be taken when sampling controls from persons with specific diseases which are apparently "unrelated" to exposure because confounding may be introduced by exposure-related determinants of the control disease(s). To remove such confounding, it is necessary to control for risk factors for both the study disease and the control disease(s).
epidemiologic methods; research design
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