To the Editor: In their case-control study
of risk factors for meningococcal disease in college students, Dr Bruce and
colleagues1 report that 4 of the case subjects
(8%) died before exposure histories could be obtained, so proxy patients were
interviewed. The authors did not exclude the 4 deceased case subjects, nor
did they identify and interview proxies of the 4 matched controls. It is possible
that this introduced a small amount of bias because of the differential misclassification
of exposure. The case subjects were more likely than the control subjects
to have had their exposures misclassified. The odds ratios (ORs) may have
been biased toward or away from the null value.2
For example, the lack of a significant association between active smoking
and risk of disease may have been caused by underreporting by the 4 proxy
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