文章摘要
王晶,卓琳,詹思延.病例-病例-时间-对照设计[J].中华流行病学杂志,2014,35(12):1396-1399
病例-病例-时间-对照设计
The case-case-time-control study design
投稿时间:2014-06-17  
DOI:10.3760/cma.j.issn.0254-6450.2014.12.019
中文关键词: 病例-病例-时间-对照设计;自身病例对照设计;暴露的时间变化趋势
英文关键词: Case-case-time-control design;Self-matched case-only studies;Exposure-time trends
基金项目:
作者单位E-mail
王晶 北京大学公共卫生学院流行病与卫生统计学系 100191  
卓琳 北京大学公共卫生学院流行病与卫生统计学系 100191  
詹思延 北京大学公共卫生学院流行病与卫生统计学系 100191 siyan-zhan@bjmu.edu.cn 
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中文摘要:
      自身病例对照设计(如病例交叉设计、自身对照病例系列研究)虽然能控制不随时间变化的混杂因素(可测量或不可测量的)的影响,但是不能控制暴露时间变化趋势所带来的混杂.双向病例交叉设计可以控制暴露时间变化趋势.但是在药物流行病学的研究中,疾病状态通常影响后续的药物使用,因此这种双向病例交叉设计往往不适用.Suissa 提出的病例-时间-对照设计将病例交叉设计和病例对照设计相结合,很好地控制了暴露的时间变化趋势所带来的偏倚.但是当病例组和对照组不能良好地匹配时,可能会引入新的选择偏倚.本文介绍一种新的研究设计方法“病例-病例-时间-对照设计”,该研究设计是“病例-时间-对照设计”的衍生,即在选择对照组时并不采用外部对照,而是将未来病例作为当前病例的对照,从而避免了暴露的时间趋势所带来的混杂.文后还通过实例分析,对此方法的优点和局限性进行阐释.
英文摘要:
      Although the ‘self-matched case-only studies' (such as the case-cross-over or self-controlled case-series method) can control the time-invariant confounders (measured or unmeasured) through design of the study, however, they can not control those confounders that vary with time. A bidirectional case-crossover design can be used to adjust the exposure-time trends. In the areas of pharmaco-epidemiology,illness often influence the future use of medications, making a bidirectional study design problematic. Suissa's case-time-control design combines the case-crossover and the case-control design which could adjust for exposure-trend bias, but the control group may reintroduce selection bias, if the matching does not go well. We propose a “case-case-time-control” design which is an extension of the case-time-control design. However, rather than using a sample of external controls, we choose those future cases as controls for current cases to counter the bias that arising from temporal trends caused by exposure to the target of interest. In the end of this article we will discuss the strength and limitations of this design based on an applied example.
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