Potential for Selection Bias in Studies of the Association of Hormonal Contraception and Chronic Vulvar Pain.
Potential for Selection Bias in Studies of the Association of Hormonal Contraception and Chronic Vulvar Pain.
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激素避孕与慢性外阴疼痛关联研究中潜在的选择偏差。
DOI：
10.1089/jwh.2020.8857
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Harlow,BernardL
中科院分区：
文献类型：
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作者：
Bond,JuliaC;Kachura,JacobJ;Fox,MatthewP;Weuve,Jennifer;Harlow,BernardL
背景：激素避孕药的使用在育龄妇女中很常见，但评估其与外阴痛病因关系的研究仍然不一。我们试图评估这种关联，并检查因寻求护理行为而产生偏差的可能性。 材料和方法：我们对 2008 年至 2011 年从大型医疗保健网络数据库中招募的女性进行了病例对照研究。在 26,455 名符合条件的受访者中，1168 人符合慢性外阴疼痛 (CVP) 的病例定义。我们将每个病例与三个对照按年龄进行匹配，并使用条件逻辑回归来计算先前使用激素避孕 (HC) 和 CVP 的比值比 (OR)，根据患者是否寻求外阴疼痛护理对病例进行分层。我们还使用基于该数据集的参数模拟了因寻求护理而导致的潜在偏差的影响。结果：HC 用户出现 CVP 的几率较高（调整后 OR = 2.6，95% 置信区间 [CI]：2.2–3.2）。当病例仅限于寻求护理者时，效果估计更强（调整后 OR = 2.9，95% CI：2.2–3.7）。随着 HC 开始和疼痛发作之间时间的增加，效果估计值略有下降。我们的模拟表明，当病例仅限于寻求护理的女性，但对照组是从普通人群中招募时，效果估计可能会被虚假加强。结论：我们的结果表明，当病例仅限于寻求护理者但对照组不是时，在病例对照研究中，先前使用 HC 和 CVP 之间的关联可能会虚假加强。
Background:Hormonal contraceptive use is common among reproductive-aged women, but research evaluating its etiological relationship to vulvodynia remains mixed. We sought to evaluate this association and examine the potential for bias due to care-seeking behavior.Materials and Methods:We conducted a case–control study of women recruited from a large health care network database from 2008 to 2011. Of 26,455 eligible respondents, 1168 met the case definition for chronic vulvar pain (CVP). We matched each case to three controls by age and used conditional logistic regression to calculate odds ratios (ORs) for prior hormonal contraception (HC) use and CVP, stratifying cases by whether or not they sought care for their vulvar pain. We also simulated the influence of potential biases due to care seeking, using parameters based on this dataset.Results:HC users had higher odds of CVP (adjusted OR = 2.6, 95% confidence interval [CI]: 2.2–3.2). Effect estimates were stronger when cases were restricted to care seekers (adjusted OR = 2.9, 95% CI: 2.2–3.7). Effect estimates decreased slightly as time increased between HC initiation and pain onset. Our simulations suggested that effect estimates may be spuriously strengthened when cases are restricted to care-seeking women, but controls are recruited from the general population.Conclusions:Our results suggest an association between antecedent HC use and CVP that is potentially spuriously strengthened in case–control studies when cases are restricted to care seekers but controls are not.