在出生缺陷病例对照研究中针对因病例确诊不完全所致的偏倚进行校正。

Adjusting for bias due to incomplete case ascertainment in case-control studies of birth defects.

作者信息

Howards Penelope P, Johnson Candice Y, Honein Margaret A, Flanders W Dana

出版信息

Am J Epidemiol. 2015 Apr 15;181(8):595-607. doi: 10.1093/aje/kwu323. Epub 2015 Mar 19.

Abstract

Case-control studies of birth defects might be subject to selection bias when there is incomplete ascertainment of cases among pregnancies that are terminated after a prenatal diagnosis of the defect. We propose a simple method to estimate inverse probability of selection weights (IPSWs) for cases ascertained from both pregnancies that end in termination and those that do not end in termination using data directly available from the National Birth Defects Prevention Study and other published information. The IPSWs can then be used to adjust for selection bias analytically. We can also allow for uncertainty in the selection probabilities through probabilistic bias analysis. We provide an illustrative example using data from National Birth Defects Prevention Study (1997-2009) to examine the association between prepregnancy obesity (body mass index, measured as weight in kilograms divided by height in meters squared, of ≥30 vs. <30) and spina bifida. The unadjusted odds ratio for the association between prepregnancy obesity and spina bifida was 1.48 (95% confidence interval: 1.26, 1.73), and the simple selection bias-adjusted odds ratio was 1.26 (95% confidence interval: 1.04, 1.53). The probabilistic bias analysis resulted in a median adjusted odds ratio of 1.22 (95% simulation interval: 0.97, 1.47). The proposed method provides a quantitative estimate of the IPSWs and the bias introduced by incomplete ascertainment of cases among terminated pregnancies conditional on a set of assumptions.

摘要

当在产前诊断出缺陷后终止妊娠的孕妇中病例确定不完全时,出生缺陷的病例对照研究可能会受到选择偏倚的影响。我们提出了一种简单的方法,利用国家出生缺陷预防研究直接提供的数据和其他已发表的信息,来估计从终止妊娠和未终止妊娠的孕妇中确定的病例的选择权重逆概率(IPSW)。然后,IPSW可用于通过分析调整选择偏倚。我们还可以通过概率偏差分析来考虑选择概率中的不确定性。我们提供了一个使用国家出生缺陷预防研究(1997 - 2009年)数据的示例,以研究孕前肥胖(体重指数,以千克为单位的体重除以以米为单位的身高的平方,≥30与<30)与脊柱裂之间的关联。孕前肥胖与脊柱裂之间关联的未调整优势比为1.48(95%置信区间:1.26,1.73),简单的选择偏倚调整后优势比为1.26(95%置信区间:1.04,1.53)。概率偏差分析得出调整后优势比的中位数为1.22(95%模拟区间:0.97,1.47)。所提出的方法在一组假设的条件下,对IPSW以及终止妊娠中病例确定不完全所引入的偏倚提供了定量估计。

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