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Article
June 1984

Case-Control ResearchTemporal Precedence and Other Problems of the Exposure-Disease Relationship

Author Affiliations

From the Departments of Medicine and Epidemiology, Yale University School of Medicine, New Haven, Conn. Dr Horwitz is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine.

Arch Intern Med. 1984;144(6):1257-1259. doi:10.1001/archinte.1984.00350180201028
Abstract

• We assessed the principle of temporal precedence in recent case-control studies demonstrating the alleged associations between tampon use and toxic shock syndrome and between aspirin use and Reye's syndrome. For both relationships, we considered four components of the exposuredisease association, including: (1) establishing that the agent preceded the disease, (2) selecting an index time, (3) defining criteria for classifying a patient as "exposed," and (4) avoiding the bias that occurs when use of the etiologic agent was influenced by an early manifestation of the disease. The problems can be minimized by interviewing patients early during the course of their illness and by improving strategies for data analysis.

(Arch Intern Med 1984;144:1257-1259)

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