Analysis of case-control studies of screening: impact of misspecifying the duration of detectable preclinical pathologic changes.
Analysis of case-control studies of screening: impact of misspecifying the duration of detectable preclinical pathologic changes.
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筛查病例对照研究分析：错误指定可检测的临床前病理变化持续时间的影响。
DOI：
10.1093/oxfordjournals.aje.a009638
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发表时间：
1998
影响因子：
5
通讯作者：
Weiss,NS
中科院分区：
文献类型：
--
作者：
Etzioni,RD;Weiss,NS
在预防癌症死亡筛查的病例对照研究中，暴露理想地定义为在诊断之前的一段时间内进行的筛查，在此期间使用所研究的筛查方式可能检测到癌症。该间隔被称为可检测的临床前期（DPP）。错误指定 DPP 的持续时间可能会使此类研究的结果产生偏差。本文量化了错误估计 DPP 持续时间或使用正确的平均 DPP 但未考虑其可变性的影响。作者开发了一种有筛查和无筛查的疾病发病率和死亡率的计算机模拟模型。然后，作者从生成的人群中选择了病例和对照，并比较了他们的筛查历史。结果表明，低估 DPP 持续时间通常比高估会导致更大的偏差，但在这两种情况下，偏差的程度都会受到 DPP 的相对长度和平均筛选间隔的影响。在实践中，作者建议，为了防止错误地低估筛查测试在降低死亡率方面的有效性，在分析筛查病例对照研究的结果时，应使用 DPP 分布的高百分位。Am J Epidemiol1998；148：292-7。
In case-control studies of screening to prevent cancer mortality, exposure is ideally defined as screening that takes place within that period prior to diagnosis during which the cancer is potentially detectable using the screening modality under study. This interval has been called the detectable preclinical period (DPP). Mis-specifying the duration of the DPP can bias the results of such studies. This article quantifies the impact of incorrectly estimating the duration of the DPP or using the correct average DPP but failing to consider its variability. The authors developed a computer simulation model of disease incidence and mortality with and without screening. The authors then selected cases and controls from the generated population and compared their screening histories. The results indicate that underestimation of the duration of the DPP generally leads to greater bias than does overestimation, but in both instances the extent of the bias is modified by the relative length of the DPP and the average interscreening interval. In practice, the authors recommend that to prevent a falsely low estimate of the effectiveness of a screening test in reducing mortality, a high percentile of the DPP distribution be used when analyzing the results of case-control studies of screening.Am J Epidemiol1998;148:292–7.