Flanders W D, Longini I M
Department of Epidemiology and Biostatistics, Emory University School of Medicine, Atlanta, GA 30329.
Stat Med. 1990 Aug;9(8):969-80. doi: 10.1002/sim.4780090812.
Analysis and interpretation of observational studies of screening effectiveness is difficult because several biases threaten validity, including the structural healthy screenee bias, length bias, and effects of lead time. Although methods for the analysis of observational studies of screening effectiveness have been proposed, most have limitations such as incomplete control of length bias, or a heavy reliance on distributional assumptions. In this report we present a method for the analysis of observational cohort studies of screening effectiveness. Although developed independently and formulated specifically for estimating benefits of screening, our approach is implied by a more general approach developed previously by Robins. Our approach, in contrast to other available methods, avoids the healthy screenee bias, and length and lead time bias, and allows an empirical approach to analysis that need not depend highly on distributional assumptions. We illustrate application of the approach with analysis of published data from a study of breast cancer screening.
对筛查效果的观察性研究进行分析和解释很困难，因为有几种偏倚会威胁到有效性，包括结构性健康受检者偏倚、病程长短偏倚和领先时间效应。虽然已经提出了分析筛查效果观察性研究的方法，但大多数方法都有局限性，例如对病程长短偏倚的控制不完整，或者严重依赖分布假设。在本报告中，我们提出了一种分析筛查效果观察性队列研究的方法。虽然我们的方法是独立开发的，并且专门用于估计筛查的益处，但它是由罗宾斯之前开发的一种更通用的方法推导而来的。与其他现有方法相比，我们的方法避免了健康受检者偏倚、病程长短偏倚和领先时间偏倚，并允许采用一种经验性的分析方法，该方法不必高度依赖分布假设。我们通过分析一项乳腺癌筛查研究的已发表数据来说明该方法的应用。
