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Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2004 Aug;58(8):712–717. doi: 10.1136/jech.2003.010546

A simple model for potential use with a misclassified binary outcome in epidemiology

S Duffy 1, J Warwick 1, A Williams 1, H Keshavarz 1, F Kaffashian 1, T Rohan 1, F Nili 1, A Sadeghi-Hassanaba 1
PMCID: PMC1732865  PMID: 15252078

Abstract

Study objective: Error in determination of disease outcome occurs in epidemiology, but such error is not usually corrected for in statistical analysis. A method of correction of risk estimates for misclassification of a binary disease outcome is developed here.

Methods: The method is a simple, closed form correction to the logistic regression estimate. A closed form variance estimate is also developed.

Setting: The method is illustrated in two studies, a cross sectional survey of cervicitis in Iran in 1996–97, as determined by inflammation on cervical smear specimens, and a case-cohort study of benign proliferative epithelial disease of the breast, in Canada 1980–88.

Main results: The method provides corrected odds ratio estimates and corrects the spurious precision conferred by misclassification.

Conclusions: The method is easy to apply and potentially useful, although potential failures of the assumptions involved should be borne in mind. It is necessary to give careful consideration to the plausibility or otherwise of the assumptions in the context of the individual study. Correction for misclassification of disease outcome may become more common with the development of readily applicable methods.

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Selected References

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  1. Brenner H., Savitz D. A., Gefeller O. The effects of joint misclassification of exposure and disease on epidemiologic measures of association. J Clin Epidemiol. 1993 Oct;46(10):1195–1202. doi: 10.1016/0895-4356(93)90119-l. [DOI] [PubMed] [Google Scholar]
  2. Chavance M., Dellatolas G., Lellouch J. Correlated nondifferential misclassifications of disease and exposure: application to a cross-sectional study of the relation between handedness and immune disorders. Int J Epidemiol. 1992 Jun;21(3):537–546. doi: 10.1093/ije/21.3.537. [DOI] [PubMed] [Google Scholar]
  3. Duffy S. W., Keshavarz H., Sadeghi-Hassanabadi A., Zolghadr Z., Oboodi B. Prevalence of cervicitis in women living in southern Iran. Rev Epidemiol Sante Publique. 1999 Mar;47(1):86–86. [PubMed] [Google Scholar]
  4. Duffy S. W., Maximovitch D. M., Day N. E. External validation, repeat determination, and precision of risk estimation in misclassified exposure data in epidemiology. J Epidemiol Community Health. 1992 Dec;46(6):620–624. doi: 10.1136/jech.46.6.620. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Glaser S. L., Dorfman R. F., Clarke C. A. Expert review of the diagnosis and histologic classification of Hodgkin disease in a population-based cancer registry: interobserver reliability and impact on incidence and survival rates. Cancer. 2001 Jul 15;92(2):218–224. doi: 10.1002/1097-0142(20010715)92:2<218::aid-cncr1312>3.0.co;2-6. [DOI] [PubMed] [Google Scholar]
  6. Greenland S. The effect of misclassification in the presence of covariates. Am J Epidemiol. 1980 Oct;112(4):564–569. doi: 10.1093/oxfordjournals.aje.a113025. [DOI] [PubMed] [Google Scholar]
  7. Howell S., Theodor M., Pacey N. F., Patwardhan J. R., Ayer B. Quality assurance in cytology. Rescreening of previously negative smears from high grade squamous intraepithelial lesions. Acta Cytol. 1997 Jul-Aug;41(4):1085–1090. doi: 10.1159/000332792. [DOI] [PubMed] [Google Scholar]
  8. Keshavarz H., Duffy S. W., Sadeghi-Hassanabadi A., Zolghadr Z., Oboodi B. Risk factors for and relationship between bacterial vaginosis and cervicitis in a high risk population for cervicitis in Southern Iran. Eur J Epidemiol. 2001;17(1):89–95. doi: 10.1023/a:1010935723248. [DOI] [PubMed] [Google Scholar]
  9. Keshavarz H., Duffy S. W., Sotodeh-Maram E., Saraf Z., Sadeghi-Hassana-Badi A., Zighami B., Tabei Z. Factors related to cervicitis in Qashghaee nomadic women of southern Iran. Rev Epidemiol Sante Publique. 1997 Sep;45(4):279–285. [PubMed] [Google Scholar]
  10. Kristensen P. Bias from nondifferential but dependent misclassification of exposure and outcome. Epidemiology. 1992 May;3(3):210–215. doi: 10.1097/00001648-199205000-00005. [DOI] [PubMed] [Google Scholar]
  11. Phillips Carl V., LaPole Luwanna M. Quantifying errors without random sampling. BMC Med Res Methodol. 2003 Jun 12;3:9–9. doi: 10.1186/1471-2288-3-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Phillips Carl V. Quantifying and reporting uncertainty from systematic errors. Epidemiology. 2003 Jul;14(4):459–466. doi: 10.1097/01.ede.0000072106.65262.ae. [DOI] [PubMed] [Google Scholar]
  13. Richardson S., Gilks W. R. Conditional independence models for epidemiological studies with covariate measurement error. Stat Med. 1993 Sep 30;12(18):1703–1722. doi: 10.1002/sim.4780121806. [DOI] [PubMed] [Google Scholar]
  14. Rohan T. E., Jain M., Miller A. B. A case-cohort study of diet and risk of benign proliferative epithelial disorders of the breast (Canada). Cancer Causes Control. 1998 Jan;9(1):19–27. doi: 10.1023/a:1008841118358. [DOI] [PubMed] [Google Scholar]
  15. Rosner B., Spiegelman D., Willett W. C. Correction of logistic regression relative risk estimates and confidence intervals for measurement error: the case of multiple covariates measured with error. Am J Epidemiol. 1990 Oct;132(4):734–745. doi: 10.1093/oxfordjournals.aje.a115715. [DOI] [PubMed] [Google Scholar]
  16. Shih J. H., Albert P. S. Latent model for correlated binary data with diagnostic error. Biometrics. 1999 Dec;55(4):1232–1235. doi: 10.1111/j.0006-341x.1999.01232.x. [DOI] [PubMed] [Google Scholar]

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