Dose-response in case-control studies.

The evidence provided by a case-control study on the association between a disease and some factor is strengthened if the extent of exposure to the factor is categorised into several groups or measured on a continuous scale. Then dose-response relationships can be estimated. The methods available are illustrated by application to data on lung cancer and chrysotile asbestos exposure from Quebec in which there were three matched controls for each case. Regression-type models were fitted assuming that the relative risk of lung cancer was linearly related to an exposure measure; a covariate, smoking, was also included in the analysis. The data were first analysed ignoring the matching and secondly taking account of the matching. The methodology for the latter analysis has only recently been developed; formerly, matched studies were of necessity analysed as unmatched. Although, in this particular example, the unmatched and matched analyses gave similar results, this is not always the case and it is argued that, now that the methodology is available, matched case-control studies should be analysed taking proper account of the matching.