Periodontal researchers frequently use case-control studies, but information on participation rates and the reasons for participation are often missing in the publications, thus hindering the assessment of the validity of those studies. A nested case-control study based on a well-defined population was used to (i) describe the patterns of participation; (ii) show how some associations can be biased; and (iii) illustrate how inverse probability weights can be applied to reduce bias. Differential subject participation was quantified using the ratio between participation for each level and the overall participation. Possible biased associations were illustrated using the odds ratios found for eligible and participant subjects. Finally, we used the estimated probability that an individual participates in the case-control study conditional on that individual's covariate pattern, as observed in the screening study to attempt bias reduction. Considerable differential participation was observed for selected factors, including age, annual tuitions and fees, parental income, and parental education. The strategy used for adjustment of bias resulted in some degree of bias reduction. These findings challenge the inferential validity of many studies on periodontitis. The design and conduct of these studies should aim to improve subject participation and must consider and minimize this potential source of bias.

译文

牙周研究人员经常使用病例对照研究,但是出版物中经常缺少有关参与率和参与原因的信息,因此阻碍了对这些研究有效性的评估。基于明确定义的人群的嵌套病例对照研究用于 (i) 描述参与模式; (ii) 显示某些关联如何产生偏差; (iii) 说明如何应用反向概率权重来减少偏差。使用每个级别的参与与总体参与之间的比率来量化受试者的不同参与。使用合格受试者和参与者受试者的比值比说明了可能的偏倚关联。最后,我们使用了在筛选研究中观察到的以个体的协变量模式为条件的个体参与病例对照研究的估计概率,以尝试减少偏倚。对于选定的因素,包括年龄,年度学费和费用,父母收入和父母教育,观察到相当大的参与程度。用于调整偏差的策略导致一定程度的偏差减少。这些发现挑战了许多牙周炎研究的推论有效性。这些研究的设计和实施应旨在提高受试者的参与度,并且必须考虑并最大程度地减少这种潜在的偏见来源。

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