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January 15, 1982, Vol 247, No. 3 >
ARTICLE | January 15, 1982

The Case-Control Study: Title and subTitle BreakA Practical Review for the Clinician FREE

Gregory F. Hayden, MD; Michael S. Kramer, MD; Ralph I. Horwitz, MD
[+] Author Affiliations

Reprint requests to the Department of Pediatrics, University of Virginia Medical Center, Charlottesville, VA 22908 (Dr Hayden).


JAMA. 1982;247(3):326-331. doi:10.1001/jama.1982.03320280046028
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References

The retrospective case-control study is an important research strategy commonly encountered in the medical literature. A thoughtfully designed, carefully executed case-control study can be an invaluable source of clinical information, and physicians must often base important decisions about patient counseling and management on their interpretation of such studies. Unfortunately, the retrospective direction of case-control studies—looking "backwards" from an outcome event to an antecedent exposure—is accompanied by numerous methodological hazards. Careful attention must be paid to selection of appropriate study groups; definition and detection of the outcome event; definition and ascertainment of the exposure; assurance that the compared groups were equally susceptible to the outcome event at baseline; and careful statistical analysis. If systematic bias enters the research at any of these points, erroneous conclusions can result. Greater familiarity with the case-control method should enable clinicians to be more critically insightful when interpreting the results of published studies using this design format.

(JAMA 1982;247:326-331)

REFERENCES

1 +
Horwitz RI, Feinstein AR:  Methodologic standards and contradictory results in casecontrol research . Am J Med 1979;;66:556-564.
2 +
Feinstein AR:  Clinical biostatistics: 20. The epidemiologic trohoc, the ablative risk ratio and 'retrospective' research . Clin Pharmacol Ther 1973;;14:291-307.
3 +
Beattie AD, Moore MR, Goldberg A, et al:  Role of chronic low-level lead exposure in the etiology of mental retardation . Lancet 1975;; 1:589-592.
4 +
 Reserpine use in relation to breast cancer, Boston Collaborative Drug Surveillance Program . Lancet 1974;;2:669-671.
5 +
Heinonen OP, Shapiro S, Tuminen L, et al:  Reserpine use in relation to breast cancer . Lancet 1974;;2:675-677.
6 +
Brown GW:  Berkson fallacy revisited: Spurious conclusions from patient surveys . Am J Dis Child 1976;;130:56-60.
7 +
Hellstrom B, Lindsten J, Nilsson K:  Prenatal sex-hormone exposure and congenital limb-reduction defects . Lancet 1976;;2:372-373.
8 +
Gal I:  Risks and benefits of the use of hormonal pregnancy test tablets . Nature 1972;; 240:241-242.
9 +
Roberts RS, Spitzer WO, Sackett DL, et al:  An empirical demonstration of Berkson's bias . J Chronic Dis 1978;;31:119-128.
10 +
Cole P:  The evolving case-control study . J Chronic Dis 1979;;32:15-27.
11 +
Sartwell PE:  Retrospective studies: A review for the clinician . Ann Intern Med 1974;; 81:381-386.
12 +
Ibrahim MA, Spitzer WD:  The casecontrol study: The problem and the prospect . J Chronic Dis 1979;;32:139-144.
13 +
Halsey NA, Modlin JF, Jabbour JT, et al:  Risk factors in subacute sclerosing panencephalitis: A case-control study . Am J Epidemiol 1980;;111:415-424.
14 +
Nelson DB, Kimbrough R, Landrigan PS, et al:  Aflatoxin and Reye's syndrome: A casecontrol study . Pediatrics 1980;;66:865-869.
15 +
Gutensohn N, Li F, Johnson R, et al:  Hodgkin's disease, tonsillectomy and family size . N Engl J Med 1975;;292:22-25.
16 +
Armstrong B, Stevens N, Doll R:  Retrospective study of the association between use of Rauwolfia derivatives and breast cancer in English women . Lancet 1974;;2:672-675.
17 +
Mehta P, Vasa R, Neumann L, et al:  Thrombocytopenia in the high-risk infant . J Pediatr 1980;;97:791-794.
18 +
Horwitz RI, Feinstein AR:  Alternative analytic methods for case-control studies of estrogens and endometrial cancer . N Engl J Med 1978;;299:1089-1094.
19 +
Antunes CM, Stolley PD, Rosenshein NB, et al:  Endometrial cancer and estrogen use: Report of a large case-control study . N Engl J Med 1979;;300:9-13.
20 +
Hulka BS, Grimson RC, Greenberg BG, et al:  'Alternative' controls in a case control study of endometrial cancer and exogenous estrogen . Am J Epidemiol 1980;;112:376-387.
21 +
Shapiro S, Kaufman DW, Slone D, et al:  Recent and past use of conjugated estrogen in relation to adenocarcinoma of the endometrium . N Engl J Med 1980;;303:485-489.
22 +
Ransohoff DF, Feinstein AR:  Problems of spectrum and bias in evaluating the efficacy of diagnostic tests . N Engl J Med 1978;;299:926-930.
23 +
Janerich DR, Flink EM, Keogh MD:  Down's syndrome and oral contraceptive usage . Br J Obstet Gynaecol 1976;;83:617-620.
24 +
Klemetti A, Saxen L:  Prospective versus retrospective approach in the search for environmental causes of malformation . Am J Public Health 1967;;57:2971-2975.
25 +
Deykin EY, MacMahon B:  Pregnancy, delivery, and neonatal complications among autistic children . Am J Dis Child 1980;;134:860-864.
26 +
Horwitz M, Bennett JV:  Nursery outbreak of peritonitis with pneumoperitoneum probably caused by thermometer-induced rectal perforation . Am J Epidemiol 1976;;104:632-644.
27 +
Laurence KM:  Reply to Gal . Nature 1972;; 240:242.
28 +
Kramer MS, Moroz B:  Do breast feeding and delayed solids protect against subsequent atopic eczema? J Pediatr 1981;;98:546-550.
29 +
Greenburg G, Inman WH, Weatherall JA, et al:  Maternal drug histories and congenital abnormalities . Br Med J 1977;;2:853-856.
30 +
Charney E, Sayre J, Coulter M:  Increased lead absorption in inner city children: Where does the lead come from? Pediatrics 1980;;65:226-231.
31 +
Horwitz RI, Feinstein AR:  The problem of 'protopathic bias' in case-control studies . Am J Med 1980;;68:255-258.
32 +
Cornfield J:  A method for estimating comparative rates for clinical data . JNCI 1950;-1951;11:1269-1275.
33 +
Fleiss JL:  Confidence intervals for the odds ratio in case-control studies: The state of the art . J Chronic Dis 1979;;32:69-77.
34 +
Feinstein AR:  Clinical biostatistics 34. The other side of 'statistical significance': Alpha, beta, delta, and the calculation of sample size . Clin Pharmacol Ther 1975;;18:491-505.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Horwitz RI, Feinstein AR:  Methodologic standards and contradictory results in casecontrol research . Am J Med 1979;;66:556-564.
2 +
Feinstein AR:  Clinical biostatistics: 20. The epidemiologic trohoc, the ablative risk ratio and 'retrospective' research . Clin Pharmacol Ther 1973;;14:291-307.
3 +
Beattie AD, Moore MR, Goldberg A, et al:  Role of chronic low-level lead exposure in the etiology of mental retardation . Lancet 1975;; 1:589-592.
4 +
 Reserpine use in relation to breast cancer, Boston Collaborative Drug Surveillance Program . Lancet 1974;;2:669-671.
5 +
Heinonen OP, Shapiro S, Tuminen L, et al:  Reserpine use in relation to breast cancer . Lancet 1974;;2:675-677.
6 +
Brown GW:  Berkson fallacy revisited: Spurious conclusions from patient surveys . Am J Dis Child 1976;;130:56-60.
7 +
Hellstrom B, Lindsten J, Nilsson K:  Prenatal sex-hormone exposure and congenital limb-reduction defects . Lancet 1976;;2:372-373.
8 +
Gal I:  Risks and benefits of the use of hormonal pregnancy test tablets . Nature 1972;; 240:241-242.
9 +
Roberts RS, Spitzer WO, Sackett DL, et al:  An empirical demonstration of Berkson's bias . J Chronic Dis 1978;;31:119-128.
10 +
Cole P:  The evolving case-control study . J Chronic Dis 1979;;32:15-27.
11 +
Sartwell PE:  Retrospective studies: A review for the clinician . Ann Intern Med 1974;; 81:381-386.
12 +
Ibrahim MA, Spitzer WD:  The casecontrol study: The problem and the prospect . J Chronic Dis 1979;;32:139-144.
13 +
Halsey NA, Modlin JF, Jabbour JT, et al:  Risk factors in subacute sclerosing panencephalitis: A case-control study . Am J Epidemiol 1980;;111:415-424.
14 +
Nelson DB, Kimbrough R, Landrigan PS, et al:  Aflatoxin and Reye's syndrome: A casecontrol study . Pediatrics 1980;;66:865-869.
15 +
Gutensohn N, Li F, Johnson R, et al:  Hodgkin's disease, tonsillectomy and family size . N Engl J Med 1975;;292:22-25.
16 +
Armstrong B, Stevens N, Doll R:  Retrospective study of the association between use of Rauwolfia derivatives and breast cancer in English women . Lancet 1974;;2:672-675.
17 +
Mehta P, Vasa R, Neumann L, et al:  Thrombocytopenia in the high-risk infant . J Pediatr 1980;;97:791-794.
18 +
Horwitz RI, Feinstein AR:  Alternative analytic methods for case-control studies of estrogens and endometrial cancer . N Engl J Med 1978;;299:1089-1094.
19 +
Antunes CM, Stolley PD, Rosenshein NB, et al:  Endometrial cancer and estrogen use: Report of a large case-control study . N Engl J Med 1979;;300:9-13.
20 +
Hulka BS, Grimson RC, Greenberg BG, et al:  'Alternative' controls in a case control study of endometrial cancer and exogenous estrogen . Am J Epidemiol 1980;;112:376-387.
21 +
Shapiro S, Kaufman DW, Slone D, et al:  Recent and past use of conjugated estrogen in relation to adenocarcinoma of the endometrium . N Engl J Med 1980;;303:485-489.
22 +
Ransohoff DF, Feinstein AR:  Problems of spectrum and bias in evaluating the efficacy of diagnostic tests . N Engl J Med 1978;;299:926-930.
23 +
Janerich DR, Flink EM, Keogh MD:  Down's syndrome and oral contraceptive usage . Br J Obstet Gynaecol 1976;;83:617-620.
24 +
Klemetti A, Saxen L:  Prospective versus retrospective approach in the search for environmental causes of malformation . Am J Public Health 1967;;57:2971-2975.
25 +
Deykin EY, MacMahon B:  Pregnancy, delivery, and neonatal complications among autistic children . Am J Dis Child 1980;;134:860-864.
26 +
Horwitz M, Bennett JV:  Nursery outbreak of peritonitis with pneumoperitoneum probably caused by thermometer-induced rectal perforation . Am J Epidemiol 1976;;104:632-644.
27 +
Laurence KM:  Reply to Gal . Nature 1972;; 240:242.
28 +
Kramer MS, Moroz B:  Do breast feeding and delayed solids protect against subsequent atopic eczema? J Pediatr 1981;;98:546-550.
29 +
Greenburg G, Inman WH, Weatherall JA, et al:  Maternal drug histories and congenital abnormalities . Br Med J 1977;;2:853-856.
30 +
Charney E, Sayre J, Coulter M:  Increased lead absorption in inner city children: Where does the lead come from? Pediatrics 1980;;65:226-231.
31 +
Horwitz RI, Feinstein AR:  The problem of 'protopathic bias' in case-control studies . Am J Med 1980;;68:255-258.
32 +
Cornfield J:  A method for estimating comparative rates for clinical data . JNCI 1950;-1951;11:1269-1275.
33 +
Fleiss JL:  Confidence intervals for the odds ratio in case-control studies: The state of the art . J Chronic Dis 1979;;32:69-77.
34 +
Feinstein AR:  Clinical biostatistics 34. The other side of 'statistical significance': Alpha, beta, delta, and the calculation of sample size . Clin Pharmacol Ther 1975;;18:491-505.

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