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The Role of Susceptibility Bias in Epidemiologic Research
Ralph I. Horwitz, MD;
Michael J. McFarlane, MD;
Troyen A. Brennan, MD;
Alvan R. Feinstein, MD
Arch Intern Med. 1985;145(5):909-912.
Abstract
• Because prognostic adjustment in epidemiologic studies of disease etiology has usually been limited to matchings or stratifications based on demographic characteristics, clinical sources of susceptibility bias have received little attention. This may have led to an incorrect association in two prominent epidemiologic relationships: that between clear-cell vaginal carcinoma and the use of diethylstilbestrol to treat women with bleeding or previous pregnancy loss; and that in the conflicting results of the studies linking sex steroids to the risk of birth defects. The recognition and management of susceptibility bias requires attention to the patients' clinical status at the time of exposure to the alleged causative agent, and also requires collecting and analyzing clinical data excluded or ignored in most epidemiologic studies. To avoid susceptibility bias, data about bleeding, threatened abortion, and other clinical reasons for prescribing therapy are needed for the appropriate matchings or stratifications.
(Arch Intern Med 1985;145:909-912)
Author Affiliations
From the Departments of Medicine (Drs Horwitz and Feinstein) and Epidemiology (Drs Horwitz and Feinstein) and the Robert Wood Johnson Clinical Scholars Program (Drs McFarlane and Feinstein), Yale University School of Medicine (Dr Brennan), New Haven, Conn. Dr Horwitz is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.
Footnotes
Accepted for publication Aug 1, 1984.
Reprint requests to Clinical Scholars Program, Yale University School of Medicine, 333 Cedar St, PO Box 3333, New Haven, CT 06510 (Dr Horwitz).
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