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"Nondifferential misclassification means that the frequency of errors is approximately the same in the groups being compared. However, in other studies that are conducted in difficult circumstances (e.g., a prospective cohort study in a homeless population in which one would expect difficulty maintaining follow-up) or in poorly designed studies, biases may have a major impact and produce large overestimates or underestimates of the true association. They were referred from all over the state. Emphysema is a disease that may go undiagnosed without unusual medical attention. As a result the study had a tendency to over sample women who had both the exposure and the outcome of interest.Aschengrau and Seage suggest that this selection bias could have been minimized by more restrictive case selection criteria, such that only women who clearly required hospitalization would be enrolled in the case group.This form of selection bias could be more common in a Selection bias can occur if selection or choice of the exposed or unexposed subjects in a retrospective cohort study is somehow related to the outcome of interest.Consider a hypothetical investigation of an occupational exposure (e.g., an organic solvent) that occurred 15-20 years ago in factory. The interviews indicated that 70% of the cases used oral contraceptives, but only 20% of the controls used them. Unless steps were taken to ensure comparable follow-up, an information bias would result. Those who are not healthy are less likely to be employed, while the employed work force tends to have fewer sick people. However, it is likely that in this scenario the misclassification would occur with more or less equal frequency regardless of the eventual disease status. This would result in bias toward the null. One needs to consider how heavily the individual smoked, the duration, how long ago they started, whether and when they stopped, and even whether they inhaled or whether they were exposed to environmental smoke.
We glibly talk about smokers and non-smokers, but what do these terms really mean? 'Suppose a case-control study was conducted to examine the association between a high fat diet and coronary artery disease.

As a result, the odds ratio = 6.53 gives an unbiased estimate ratio of the risk ratio.In contrast, suppose that in the same hypothetical study controls were somewhat more likely to be chosen if they had the exposure being studied. Subjects completing questionnaires or being interviewed may have difficulty in remembering past exposures. if the exposure is not dichotomous, then nondifferential misclassification may bias the estimate either toward the null or away from it, depending on the categories into which subjects are misclassified.Nondifferential misclassification can occur in a number of ways. The converse is also true: even if the selection and retention into the study is a fair representation of the population from which the samples were drawn, the estimate of association can be biased if subjects are incorrectly categorized with respect to their exposure status or outcome. Since this was a questionnaire study, recall bias could also have affected the result.
Eventually, a retrospective cohort study was conducted using the employee health records. Cases with a recent diagnosis of lung cancer were identified and interviewed about their past exposures, including a detailed history of smoking tobacco. As a result, health care providers were vigilant of their patients on oral contraceptives and were more likely to admit them to the hospital if they developed venous thrombosis or any signs or symptoms suspicious of thromboembolism. Consequently, record retention was 99% among workers who were exposed and developed health problemsDifferential loss of records results in selection bias and an overestimate of the association in this case, although depending on the scenario, this type of selection bias could also result in an underestimate of an associaton.Prospective cohort studies will not have selection bias as they enroll subjects, because the outcomes are unknown at the beginning of a prospective cohort study. Misclassification of outcomes can also introduce bias into a study, but it usually has much less of an impact than misclassification of exposure. J … However, if one sampled the population in a fair way, such the sampling from all four cells was fair and representative of the distribution of exposure and outcome in the overall population, then one can obtain an accurate estimate of the true association (assuming a large enough sample, so that random error is minimal and assuming there are no other biases or confounding).

If all records had been retained the results might have looked like those shown in the first contingency table below.This unbiased data would give a risk ratio as follows:However, suppose that many of the old records had been lost or discarded, but,given the suspicions about the effects of the solvent, the records of employees who had worked with the solvents and subequently had health problems were more likely to be retained.

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