期刊
AMERICAN JOURNAL OF EPIDEMIOLOGY
卷 184, 期 5, 页码 345-353出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kww064
关键词
causal inference; directed acyclic graphs; epidemiologic methods; influenza; observational studies; test-negative study design; vaccine effectiveness
资金
- Health and Medical Research Fund, Food and Health Bureau, Government of the Hong Kong Special Administrative Region
- Harvard Center for Communicable Disease Dynamics (National Institute of General Medical Sciences) [U54GM088558]
- Research Grants Council of the Hong Kong Special Administrative Region [T11-705/14N]
- Australian Government Department of Health
Influenza viruses undergo frequent antigenic changes. As a result, the viruses circulating change within and between seasons, and the composition of the influenza vaccine is updated annually. Thus, estimation of the vaccine's effectiveness is not constant across seasons. In order to provide annual estimates of the influenza vaccine's effectiveness, health departments have increasingly adopted the test-negative design, using enhanced data from routine surveillance systems. In this design, patients presenting to participating general practitioners with influenza-like illness are swabbed for laboratory testing; those testing positive for influenza virus are defined as cases, and those testing negative form the comparison group. Data on patients' vaccination histories and confounder profiles are also collected. Vaccine effectiveness is estimated from the odds ratio comparing the odds of testing positive for influenza among vaccinated patients and unvaccinated patients, adjusting for confounders. The test-negative design is purported to reduce bias associated with confounding by health-care-seeking behavior and misclassification of cases. In this paper, we use directed acyclic graphs to characterize potential biases in studies of influenza vaccine effectiveness using the test-negative design. We show how studies using this design can avoid or minimize bias and where bias may be introduced with particular study design variations.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据