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American Journal of Epidemiology Vol. 134, No. 9: 1003-1008
Copyright © 1991 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Response Bias in a Case-Control Study: Analysis Utilizing Comparative Data Concerning Legal Abortions from Two Independent Swedish Studies

Britt-Marie Lindefors-Harris1,, Gunnar Eklund1, Hans-Olov Adami2 and Olav Meirik3

1Department of Cancer Epidemiology, Radiumhemmet, Karolinska Institute and Karolinska Hospital S-104 01 Stockholm, Sweden
2Department of Surgery, University Hospital S-751 85 Uppsala, Sweden
3Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization Geneva, Switzerland

Reprint requests to Dr. Britt-Marie Lindefors-Hams, Department of Cancer Epidemiology, Radiumhemmet, Karolinska institute and Karolinska Hospital, S-104 01 Stockholm, Sweden

Independent reports of legal abortions in two Swedish epidemiologic studies of breast cancer in young women, covering the same women and overlapping the same time period, have been compared in order to estimate a putative response bias. One study used case-control methods and obtained data by retrospective interviews from 317 cases and 512 controls. The other study was based on objectively documented information from a nationwide registry covering legally induced abortions. Analysis demonstrated a ratio between the odds ratios from the two studies of 1 .5 (95 percent confidence interval 1.1–2.1) and an observed ratio of 22.4 (p < 0.007) between underreporting of previous induced abortions among controls relative to overreporting among cases. This response bias may explain the tendency toward increased risk of breast cancer which, according to several case-control studies, appears to be associated with induced abortion.

abortion, legal; epidemiologic methods; interviews; neoplasms; registries; retrospective studies


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