Accuracy loss due to selection bias in cohort studies with left truncation.

Accuracy loss due to selection bias in cohort studies with left truncation.
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DOI:
10.1111/ppe.12073
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发表时间:
2013-09
影响因子:
2.8
通讯作者:
Platt RW
Platt RW
中科院分区:
医学3区
文献类型:
--
作者:
Schisterman EF;Cole SR;Ye A;Platt RW

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选择是儿科和围产期流行病学中的一个常见问题,截断可以被认为是可能导致选择偏倚的失踪人员时间。左截断,也称为延迟或交错进入,可能会导致选择偏差和/或对精度产生不利影响。有两种左截断:固定左截断,其中开始的后续行动是在一个设定的时间,和可变左截断,其中后续行动开始在一个随机变化的时间点。使用数据从时间到怀孕的研究,增加了模拟研究,我们证明了固定和可变截断估计的风险比的影响。首先,固定或可变的非微分左截断导致精度损失。固定或可变差分左截断会导致偏向或远离空值以及精度损失。这种偏差的程度和方向是暴露和结果之间关联的大小和方向的函数,并且发生在常见场景和广泛的条件下。模拟研究表明,左截断导致的选择偏差会对推理产生严重影响,特别是在固定或可变差分左截断的情况下。在流行病学研究中,正确解释左截断与正确解释右删失同样重要。
Selection is a common problem in paediatric and perinatal epidemiology, and truncation can be thought of as missing person time that can result in selection bias. Left truncation, also known as late or staggered entry, may induce selection bias and/or adversely affect precision. There are two kinds of left truncation: fixed left truncation where the start of follow-up is initiated at a set time, and variable left truncation where follow-up begins at a stochastically varying time-point. Using data from a time-to-pregnancy study, augmented by a simulation study, we demonstrate the effects of fixed and variable truncation on estimates of the hazard ratio. First, fixed or variable non-differential left truncation results in a loss of precision. Fixed or variable differential left truncation results in a bias either towards or away from the null as well as a loss of precision. The extent and direction of this bias is a function of the size and direction of the association between exposure and outcome, and occurs in common scenarios and under a wide range of conditions. As demonstrated in simulation studies, selection bias due to left truncation could have a serious impact on inferences, especially in the case of fixed or variable differential left truncation. When present in epidemiologic studies, proper accounting for left truncation is just as important as proper accounting for right censoring.
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