Effects of nondifferential exposure misclassification in ecologic studies.

Although many authors have argued against inferring individual-level exposure-disease relations from ecologic data because of the potential "ecological fallacy." the availability of data from diverse populations promotes the continued use of this rapid and inexpensive study design. In ecologic studies, the exposure status of groups is often defined by the proportion of individuals exposed. In these studies, nondifferential exposure misclassification of individuals is shown to produce overestimation of exposure-disease associations that may be extreme when the ecologically derived rate ratios are applied to individuals. This overestimation contrasts with the bias toward the null resulting from nondifferential misclassification of a binary exposure in epidemiologic studies conducted at the individual level. Given the magnitude of the potential bias from nondifferential exposure misclassification and other sources, quantitative estimates of individual-level rate ratios from ecologic data should be interpreted with extreme caution.