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American Journal of Epidemiology Advance Access originally published online on September 7, 2009
American Journal of Epidemiology 2009 170(8):975-985; doi:10.1093/aje/kwp226
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American Journal of Epidemiology Published by the Johns Hopkins Bloomberg School of Public Health 2009.

PRACTICE OF EPIDEMIOLOGY

Control Selection and Participation in an Ongoing, Population-based, Case-Control Study of Birth Defects

The National Birth Defects Prevention Study

Mary E. Cogswell, Rebecca H. Bitsko, Marlene Anderka, Alissa R. Caton, Marcia L. Feldkamp, Stacey M. Hockett Sherlock, Robert E. Meyer, Tunu Ramadhani, James M. Robbins, Gary M. Shaw, T. J. Mathews, Marjorie Royle, Jennita Reefhuis and the National Birth Defects Prevention Study

Correspondence to Dr. Mary E. Cogswell, Centers for Disease Control and Prevention, Mailstop E-86, 1600 Clifton Road, NE, MS E-86, Atlanta, GA 30329-4027 (e-mail: mcogswell{at}cdc.gov).

Received for publication April 2, 2009. Accepted for publication July 1, 2009.

To evaluate the representativeness of controls in an ongoing, population-based, case-control study of birth defects in 10 centers across the United States, researchers compared 1997–2003 birth certificate data linked to selected controls (n = 6,681) and control participants (n = 4,395) with those from their base populations (n = 2,468,697). Researchers analyzed differences in population characteristics (e.g., percentage of births at ≥2,500 g) for each group. Compared with their base populations, control participants did not differ in distributions of maternal or paternal age, previous livebirths, maternal smoking, or diabetes, but they did differ in other maternal (i.e., race/ethnicity, education, entry into prenatal care) and infant (i.e., birth weight, gestational age, and plurality) characteristics. Differences in distributions of maternal, but not infant, characteristics were associated with participation by selected controls. Absolute differences in infant characteristics for the base population versus control participants were ≤1.3 percentage points. Differences in infant characteristics were greater at centers that selected controls from hospitals compared with centers that selected controls from electronic birth certificates. These findings suggest that control participants in the National Birth Defects Prevention Study generally are representative of their base populations. Hospital-based control selection may slightly underascertain infants affected by certain adverse birth outcomes.

case-control studies; congenital abnormalities; selection bias

Abbreviations: NBDPS, National Birth Defects Prevention Study; SPR, selection probability ratio


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