Adjusting for selection bias in retrospective, case-control studies

Retrospective case–control studies are more susceptibleto selection bias than other epidemiologic studies as by designthey require that both cases and controls are representativeof the same population. However, as cases and control recruitmentprocesses are often different, it is not always obvious thatthe necessary exchangeability conditions hold. Selection biastypically arises when the selection criteria are associatedwith the risk factor under investigation. We develop a methodwhich produces bias-adjusted estimates for the odds ratio. Ourmethod hinges on 2 conditions. The first is that a variablethat separates the risk factor from the selection criteria canbe identified. This is termed the "bias breaking" variable.The second condition is that data can be found such that a bias-correctedestimate of the distribution of the bias breaking variable canbe obtained. We show by means of a set of examples that suchbias breaking variables are not uncommon in epidemiologic settings.We demonstrate using simulations that the estimates of the oddsratios produced by our method are consistently closer to thetrue odds ratio than standard odds ratio estimates using logisticregression. Further, by applying it to a case–controlstudy, we show that our method can help to determine whetherselection bias is present and thus confirm the validity of studyconclusions when no evidence of selection bias can be found.