PubMed · 5796532
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B Andersen. 1969-06-05. [Berkson's fallacy].. https://pubmed.ncbi.nlm.nih.gov/5796532/
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An important issue within health services research is the correct allocation of resources within health authority regions and the capability of public health professionals to make such allocation appropriately. This allocation is often based on a mapping of relevant disease incidence and the assessment of the geographical distribution of relative risk of disease in small areas within the health authority administrative domain. Existing methods for the statistical analysis of small area risk are mostly based on smoothing methods. However, these methods often smooth over large discontinuities in the risk surface which might be important to maintain for the purposes of resource allocation. In this paper we propose a method that involves the use of spatial mixtures of components that can provide a balance between smoothness and the maintenance of discontinuity. The method is applied to a sudden infant death incidence data set.
For a variety of purposes it is increasingly necessary to establish the health needs of local populations. Following a critique of existing proxies of need, this paper presents and evaluates an alternative which draws upon epidemiological evidence concerning the age, sex and social class distribution of morbidity in order to estimate the prevalence of specific conditions in designated populations. By way of demonstrating the insights to be gained through the use of these indicative prevalence rates, the paper considers the treatment of ischaemic heart disease in a sample of 539 practices and presents evidence regarding the significance of deprivation and rurality in determining health service use relative to needs.
There is increasing interest in studying the epidemiology of subjects with mild to moderate chronic renal insufficiency (CRI), defined as reduced glomerular filtration rate (GFR) not requiring renal replacement therapy. This review discusses some of the methodological challenges presented by the epidemiological study of mild to moderate CRI that have not been adequately addressed in the literature. Issues that relate to defining the prevalence of CRI include between-laboratory differences in serum creatinine (SCr) assays, within-person measurement errors in SCr, and differences in SCr in different demographic groups that are independent of GFR. Issues that relate to examining CRI as an outcome include the choice between a "slope" or "threshold" analysis. Issues that relate to examining CRI as an exposure include the choice of renal function measure (for example, SCr vs. estimated GFR) in multivariable analysis, whether to normalize renal function to body surface area or other body size parameters, potential effect modification of the association between CRI and the outcome and the complex relation between CRI, adverse outcomes, potential confounders and intermediary variables. As we enter an era of more intensive study of mild to moderate CRI, recognition of these potential pitfalls should guide researchers toward improving the quality of epidemiological research in this field.