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BMC Medical Research Methodology
Published in: BMC Medical Research Methodology 1/2017

Open Access 01-12-2017 | Research article

Accounting for misclassification bias of binary outcomes due to underscreening: a sensitivity analysis

Authors: Nanhua Zhang, Si Cheng, Lilliam Ambroggio, Todd A. Florin, Maurizio Macaluso

Published in: BMC Medical Research Methodology | Issue 1/2017

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Abstract

Background

Diagnostic tests are performed in a subset of the population who are at higher risk, resulting in undiagnosed cases among those who do not receive the test. This poses a challenge for estimating the prevalence of the disease in the study population, and also for studying the risk factors for the disease.

Methods

We formulate this problem as a missing data problem because the disease status is unknown for those who do not receive the test. We propose a Bayesian selection model which models the joint distribution of the disease outcome and whether testing was received. The sensitivity analysis allows us to assess how the association of the risk factors with the disease outcome as well as the disease prevalence change with the sensitivity parameter.

Results

We illustrated our model using a retrospective cohort study of children with asthma exacerbation that were evaluated for pneumonia in the emergency department. Our model found that female gender, having fever during ED or at triage, and having severe hypoxia are significantly associated with having radiographic pneumonia. In addition, simulation studies demonstrate that the Bayesian selection model works well even under circumstances when both the disease prevalence and the screening proportion is low.

Conclusion

The Bayesian selection model is a viable tool to consider for estimating the disease prevalence and in studying risk factors of the disease, when only a subset of the target population receive the test.
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Metadata
Title
Accounting for misclassification bias of binary outcomes due to underscreening: a sensitivity analysis
Authors
Nanhua Zhang
Si Cheng
Lilliam Ambroggio
Todd A. Florin
Maurizio Macaluso
Publication date
01-12-2017
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2017
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/s12874-017-0447-9

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