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Cited by 99Statistical Methods in EpidemiologyAdvanced Causal Inference TechniquesGlobal Cancer Incidence and Screening

Bias in methods for deriving standardized morbidity ratio and attributable fraction estimates.

Greenland, Sander·1984·Statistics in Medicine
DOI 10.1002/sim.4780030206
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Abstract

This paper examines several methods for deriving standardized morbidity ratios (SMR) and attributable fraction (attributable risk percentage) estimates. We show that some of the proposed methods will, in general, produce biased estimators, although the low variance of certain estimators sometimes compensates for their bias. A few methods are based on statistical fallacies and should be avoided, especially the method of deriving the expected number of cases from a regression equation that does not include the exposure under study.

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  • If there is correlation between exposure and disease-specific mortality due to correlations with other risks or unobserved factors, the equations may under- or over-estimate the true population-attributable fraction when used with adjusted relative risks.

    “However, if there is also a correlation between exposure and disease-specific mortality, due to correlations of exposure with other risks or other unobserved factors, the above equations may result in under- (when there is positive correlation) or over-estimation (negative correlation) of the true PAF when used with adjusted RRs [32]–[36].”

    From The Preventable Causes of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors (2009) · cites this paper as [32]

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Authors
Greenland, S.
Affiliations
University of California, Los Angeles (US)
Corresponding author
Greenland, Sander
ORCID
Greenland, Sander
Venue
Statistics in Medicine
Publisher
Wiley
Published
1984-04
Volume
3
Issue
2
Pages
131-141
ISSN
  • 0277-6715 (ISSN-L)
  • 1097-0258
DOI
10.1002/sim.4780030206
OpenAlex
W2139867978
Cited by
99
References
22
Citations by year
2026: 2 · 2025: 2 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 2 · 2017: 4 · 2014: 3 · 2013: 3 · 2012: 3
FWCI
1.81
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 8229 d)
Locations
  • Statistics in Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Cancer Institute
Topics
  • Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
  • Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
Keywords
standardized morbidity ratio, attributable fraction, estimation bias, estimator variance, statistical fallacies
MeSH terms
Biometry, Humans, Morbidity, Probability, Risk

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