Attributable fractions: Bias from broad definition of exposure

  • Greenland S
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In certain special situations, simplification of an exposure measure into a dichotomy results in no bias from nondifferential misclassification when estimating the attributable fraction for "any exposure." This fact has led to recommendations to use a broad definition of exposure when estimating attributable fractions. I here review the assumptions underlying exposure simplification, focusing on the assumptions that the source and target populations have the same exposure distribution and that complete risk removal is possible. I argue that attributable fraction estimates based on dichotomization can be especially sensitive to violations of these assumptions, and hence misleading for projecting the impact of exposure reduction. I conclude that it is important to obtain and use detailed exposure and covariate information for attributable-fraction estimation.

Author-supplied keywords

  • Attributable fraction
  • Attributable risk
  • Bias
  • Biometry
  • Epidemiologic methods
  • Risk assessment
  • Statistics

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  • Sander Greenland

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