Comparability and representativeness of control groups in a case-control study of infant leukemia: a report from the Children's Oncology Group

Abstract

Traditionally, controls in US pediatric cancer studies were selected through random digit dialing. With declining participation and lack of nonparticipant information, random digit dialing (RDD) controls may be substandard. Birth certificate (BC) controls are an alternative, because they are population based and include data from nonparticipants. The authors examined controls collected by random digit dialing and birth certificates for a Children's Oncology Group case-control study of infant leukemia in 1995-2006. Demographic variables were used to assess differences in RDD and BC controls and their representativeness. RDD and BC controls did not differ significantly with regard to maternal variables (age, race, education, marital status, alcohol during pregnancy) or child variables (sex, gestational age, birth weight), but they varied in smoking during pregnancy (22% RDD controls, 12% BC controls) (P = 0.05). The study's combined control group differed significantly from US births: Mothers of controls were more likely to be older (29.8 vs. 27.2 years), white (84% vs. 59%), and married (85% vs. 67%) and to have >16 years of education (37% vs. 25%). Control children were more often full term (88% vs. 81%) and heavier (3,436 vs. 3,317 g). Finally, participating BC mothers were likely to be older and to have more education than nonparticipants. Thus, the study's control groups were comparable but differed from the population of interest.

Figure 1.

Box plot comparisons of continuous variables, Children's Oncology Group, 1995–2006. Abbreviations: BC, birth certificate [controls]; RDD, random digit dialing [controls]. One pound = 0.45 kg.

Figure 2.

Selected bar chart comparisons of categorical variables, Children's Oncology Group, 1995–2006. Abbreviations: BC, birth certificate [controls]; cig, cigarette; N-H, non-Hispanic; RDD, random digit dialing [controls].