title: Effects of disease misclassification on exposure-disease association.
abstract: OBJECTIVE
  We explore how misclassification in disease status can distort the exposure-disease association in a study with dichotomous disease and exposure status.
  
  
  METHODS
  We define the difference in population odds ratios between populations with and without disease misclassification as population-level bias and derive the bias as a function of sensitivity and specificity for observed disease status. The magnitude and direction of bias can be elucidated through analytic derivations, as illustrated with numerical examples.
  
  
  RESULTS
  Patterns of bias exist not only for nondifferential misclassification but also for some differential misclassification scenarios. We have provided conditions defined in terms of sensitivity and specificity that correspond to each pattern of bias.
  
  
  CONCLUSIONS
  Caution is needed in interpreting results when misclassification is present. Our findings can be used to assess the effects of disease misclassification in a population when sensitivity and specificity are known or can be estimated.
authors.affiliation: Department of Biostatistics, Columbia University, New York, NY, USA. qc2138@columbia.edu
authors.forename: Qixuan
authors.initials: Q
authors.lastname: Chen
authors.forename: Hanga
authors.initials: H
authors.lastname: Galfalvy
authors.forename: Naihua
authors.initials: N
authors.lastname: Duan
mesh_terms: D015982:Bias; D003627:Data Interpretation, Statistical; D003951:Diagnostic Errors / Q000009:adverse effects*; D004194:Disease / Q000145:classification*; D004812:Epidemiologic Methods; D006801:Humans; D016017:Odds Ratio; D012680:Sensitivity and Specificity