A regression-based method for estimating risks and relative risks in case-base studies

Abstract

Both the absolute risk and the relative risk (RR) have a crucial role to play in epidemiology. RR is often approximated by odds ratio (OR) under the rare-disease assumption in conventional case-control study; however, such a study design does not provide an estimate for absolute risk. The case-base study is an alternative approach which readily produces RR estimation without resorting to the rare-disease assumption. However, previous researchers only considered one single dichotomous exposure and did not elaborate how absolute risks can be estimated in a case-base study. In this paper, the authors propose a logistic model for the case-base study. The model is flexible enough to admit multiple exposures in any measurement scale-binary, categorical or continuous. It can be easily fitted using common statistical packages. With one additional step of simple calculations of the model parameters, one readily obtains relative and absolute risk estimates as well as their confidence intervals. Monte-Carlo simulations show that the proposed method can produce unbiased estimates and adequate-coverage confidence intervals, for ORs, RRs and absolute risks. The case-base study with all its desirable properties and its methods of analysis fully developed in this paper may become a mainstay in epidemiology.

Figure 1. Number of diseased subjects recruited in control sample (A); Ratio of upper and lower bound of 95% confidence intervals of prevalence odds (B), in a case-base study of 200 distinct subjects (solid lines), 2000 distinct subjects (dashed lines) and 20000 distinct subjects (dotted lines).