1 Two-stage sampling JF Boivin Version 14 November 2007 S:\BOIVIN\695\Winter 2007\Two-stage Sampling.ppt.

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Presentation transcript:

1 Two-stage sampling JF Boivin Version 14 November 2007 S:\BOIVIN\695\Winter 2007\Two-stage Sampling.ppt

2 1980s-1990s: Progress in use of administrative drug databases

3 Advantages Large Population-based Valid prescription data Long-time periods

4 Disadvantages Missing data on certain outcomes Temporal sequence not always clear Glucocorticoids  cataracts Cataract surgery  glucocorticoids Lack of data on confounders

5 NSAIDs and breast cancer

6 Previous research Poor exposure data Dose Duration Self-reports Small numbers Short follow-up Inadequate control of confounding

7 NSAIDs and breast cancer Cases: Saskatchewan cancer registry Controls: Saskatchewan population Drug exposure: 15 yr of computerized information Missing: - Over the counter drugs - Other confounding factors: Menarche Menopause Pregnancies Obesity

8 Entire population (= truth) Obese E+ E−E− cancerno cancer Not obese E+ E−E− All E+ E−E− OR= OR=2.5

9 Obese E+ E−E− cancerno cancer Not obese E+ E−E− All E+ E−E− not available computerized databases

10 What to do about missing confounder data?

11 Option #1 Do not conduct research on that topic

12 Option #2 Cohort or case-control study without data on confounder Obese women E+ E−E− cancerno cancer Not obese E+ E−E− All women E+ E−E− ? ? ? ? ? ? ? ?

13 Advantages Cheaper May be scientifically reasonable for certain questions

14 Option #3 Collect covariate data on a sample of the study subjects two-stage samples three-stage samples partial questionnaire case series only etc.

15 Two-stage sample Sampling approaches: simple random balanced etc.

16 Two-stage balanced design Obese E+ E−E− no cancer Not obese E+ E−E− All E+ E−E− cancer / (I)

17 White JE. A two-stage design for the study of the relationship between a rare exposure and a rare disease. AJE 1982 Cain KC, Breslow NE. Logistic regression analysis and efficient design for two-stage studies. AJE 1988

18 Consent for interviews Cases:49% Controls : 39% (Sharpe et al. Saskatchewan study)

19 Other related sampling designs three-stage sampling partial questionnaire confounder data on cases only

20 Obese E+ E−E− cancerno cancer Not obese E+ E− All E+ E− medical record review computerized databases Confounded data on cases only ? ? ? ?