What Does the Odds Ratio Estimate in a Case-Control Study?
Abstract
The use of the term 'odds ratio' in reporting the findings of case-control studies is technically correct, but is often misleading. The meaning of the odds ratio estimates obtained in a case-control study differs according to whether controls are selected from person-time at risk (the study base), persons at risk (the base-population at risk at the beginning of follow-up), or survivors (the population at risk at the end of follow-up). These three methods of control selection correspond to estimating the rate ratio, risk ratio, or the odds ratio respectively, by means of calculating the odds ratio in the subjects actually studied. None of these estimation procedures depends on any rare disease assumption. Where the rare disease assumption is relevant is whether the effect which is estimated (e.g. the odds ratio) is approximately equal to some other effect measure of interest (e.g. the risk ratio or rate ratio) in the underlying study base. To avoid confusion on this issue, authors should be encouraged to not only specify the manner in which controls have been selected (e.g. by density sampling) but also the corresponding effect measure which is being estimated (e.g. the rate ratio) by the 'odds ratio' which is obtained in a case-control analysis.
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The odds ratio provides an estimate of the risk or rate ratio depending on the sampling of cases and controls.
“This odds ratio provides an estimate of the risk or rate ratio depending on the sampling of cases and controls (see also Box 1 ) [ 175 , 176 ].”
From Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration (2007) · cites this paper as [176]
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Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & Initiative, F. T. S. (2007) · PLoS Medicine · doi:10.1371/journal.pmed.0040297 · Cited by 8,613 · see citing works
“This odds ratio provides an estimate of the risk or rate ratio depending on the sampling of cases and controls (see also Box 1) [175,176].”
Vandenbroucke, J. P., Elm, E. V., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & initiative, F. T. S. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00010-w1 · Cited by 3,543 · see citing works
Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., & Egger, M. (2014) · International Journal of Surgery · doi:10.1016/j.ijsu.2014.07.014 · Cited by 2,969 · see citing works
Vandenbroucke, J. P., von Elm, E., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., & Egger, M. (2007) · Epidemiology · doi:10.1097/ede.0b013e3181577511 · Cited by 2,779 · see citing works
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McMullan, C. J., Schernhammer, E. S., Rimm, E. B., Hu, F. B., & Forman, J. P. (2013) · JAMA · doi:10.1001/jama.2013.2710 · Cited by 369 · see citing works
Case-control studies: basic concepts
Vandenbroucke, J. P., & Pearce, N. (2012) · International Journal of Epidemiology · doi:10.1093/ije/dys147 · Cited by 254 · see citing works
Self-citationKnol, M. J., Vandenbroucke, J. P., Scott, P., & Egger, M. (2008) · American Journal of Epidemiology · doi:10.1093/aje/kwn217 · Cited by 189 · see citing works
Gustavsson, J., Mehlig, K., Leander, K., Strandhagen, E., Björck, L., Thelle, D. S., Lissner, L., Blennow, K., Zetterberg, H., & Nyberg, F. (2012) · Atherosclerosis · doi:10.1016/j.atherosclerosis.2011.10.011 · Cited by 41 · see citing works
- Authors
- PEARCE, N.
- Affiliations
- Wellington Hospital (NZ)
- Corresponding author
- PEARCE, NEIL
- ORCID
- PEARCE, NEIL
- Venue
- International Journal of Epidemiology
- Publisher
- Oxford University Press (OUP)
- Published
- 1993
- Volume
- 22
- Issue
- 6
- Pages
- 1189-1192
- ISSN
- 0300-5771 (ISSN-L)
- 1464-3685
- OpenAlex
- W2105900310
- Cited by
- 266
- References
- 0
- Citations by year
- 2026: 10 · 2025: 3 · 2024: 10 · 2023: 10 · 2022: 5 · 2021: 14 · 2020: 10 · 2019: 18 · 2018: 5 · 2017: 15 · 2016: 12 · 2015: 16 · 2014: 22 · 2013: 15 · 2012: 15
- FWCI
- 2.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Centre International de Recherche sur le Cancer
- Health Research Council of New Zealand
- Topics
- Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
- Keywords
- odds ratio, case-control study, control selection, rate ratios, relative risk
- MeSH terms
- Humans, Cohort Studies, Incidence, Odds Ratio, Case-Control Studies
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