International Journal of Epidemiology, Vol 28, 764-768, Copyright © 1999 by International Epidemiological Association
N McCarthy and J Giesecke
BACKGROUND: Analytical studies of reportable infectious diseases often use
the small minority of cases detected through surveillance systems. For many
diseases, notification of cases represents a non-random selection process.
Apparent differences in exposure histories may be due to biases involved in
the surveillance system selection of cases compared to randomly selected
controls. In addition, differential recall between cases and controls may
occur. One way to avoid these problems is to compare cases with another
group of cases with a different disorder selected by a similar surveillance
system, although this can introduce new biases. METHODS: In infectious
diseases cases with the same disease can be divided into aetiologically
meaningful subgroups by subtyping the pathogen. Exposure history can then
be compared between these subgroups. RESULTS: Several biases are removed.
The control group composed of other cases does not represent the exposure
history of the study base but differs from it in a predictable and useful
way. People considered as controls will have a higher incidence of general
predisposing factors than the general population. Analysis is limited to
factors associated with exposure to the infecting agent. CONCLUSIONS:
Case-case comparison is a development of case-control methodology made
possible by laboratory typing techniques. These comparisons allow a more
restricted but more refined analysis of the association of some exposures
with infection. Determination of how exposure to the infectious agent
occurred is more efficient and unbiased than in standard case-control
studies but general factors determining whether disease occurs after an
infectious exposure can not be studied.
ARTICLES
Case-case comparisons to study causation of common infectious diseases
Swedish Institute for Infectious Disease Control, Stockholm.
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