A set of training materials for professionals working in intervention epidemiology, public health microbiology and infection control and hospital hygiene.
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This is a systematic error due to the differences in response rates of participants in a study , and happens when participation in the study is related to the exposure status.
In a case-control study
it is sometimes difficult to identify controls. Some don't respond
either because they refuse, because they cannot be contacted, or because
their exposure cannot be documented. The assumption is then that
controls not included in the study (non-respondents) have the same history of exposure as controls who respond. However, if this is not true - and non-respondents exhibit exposures or outcomes which differ from those of respondents - the exposure among controls may be either overestimated or underestimated, leading to a lower or higher odds ratio. Efforts must be made to achieve high response rates (i.e. a low 'non-response rate') and prevent non-response bias.
The antithetical bias is called 'volunteer bias'
(i.e. volunteers from a specified sample may exhibit exposures or
outcomes (e.g. be healthier) different to those of non-volunteers e.g.
volunteers for screening ).
Example: the following example illustrates the consequences of non-response linked to exposure in a case-control study (non-response occurs among controls).
i.e. if the proportion of non-response is equal among exposed and unexposed controls, the OR is unchanged.
This second example illustrates the effect on the estimation of the OR when the proportion of non-response differs among exposed and unexposed controls, although the overall non-response rate among controls is still 30%, as in the first example.
i.e. if the proportion of non-response is not equal among exposed and unexposed controls, the estimated OR is biased.
The same consequence can be observed if non-response occurs among cases.
Example: a case-control study to assess the association between smoking and myocardial infarction (MI) was done using a postal questionnaire. Non-response was higher among exposed than unexposed MI cases, leading to an underestimation of the strength of association between smoking and MI.
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