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American Journal of Epidemiology Vol. 129, No. 4: 850-856
Copyright © 1989 by The Johns Hopkins University School of Hygiene and Public Health

research-article

COMPETING RISKS BIAS ARISING FROM AN OMITTED RISK FACTOR

ARTHUR SCHATZKIN1, and ERIC SLUD2

1Cancer Prevention Studies Branch, Cancer Prevention Research Program, Division of Cancer Prevention and Control, National Cancer Institute Bethesda, MD
2Information Management Services, Silver Spring, MD, and Department of Mathematics, University of Maryland College Park, MD

Reprint requests to Dr. Arthur Schatzkin, National Cancer Institute, Blair Building, Room 6A-01, 9000 Rockville Pike, Bethesda, MD 20892–4200

The authors describe a form of selection bias that may arise when a second disease selectively removes from the population persons susceptible to the primary disease of interest. Two examples of this bias are given: 1) a lack of association between an exposure and the primary disease may appear as an inverse association, and 2) a direct association between exposure and primary disease may be greatly attenuated. These examples of bias require the presence of an unknown risk factor in addition to the exposure of interest

epidemiologic methods; risk; risk factors


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