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December 5, 2001

Meningococcal Disease in College Students

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(21):2668. doi:10.1001/jama.286.21.2665

To the Editor: In their case-control study of risk factors for meningococcal disease in college students, Dr Bruce and colleagues1 report that 4 of the case subjects (8%) died before exposure histories could be obtained, so proxy patients were interviewed. The authors did not exclude the 4 deceased case subjects, nor did they identify and interview proxies of the 4 matched controls. It is possible that this introduced a small amount of bias because of the differential misclassification of exposure. The case subjects were more likely than the control subjects to have had their exposures misclassified. The odds ratios (ORs) may have been biased toward or away from the null value.2 For example, the lack of a significant association between active smoking and risk of disease may have been caused by underreporting by the 4 proxy patients.

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