title: Accounting for outcome misclassification in estimates of the effect of occupational asbestos exposure on lung cancer death.
abstract: In studies of the health effects of asbestos, lung cancer death is subject to misclassification. We used modified maximum likelihood to explore the effects of outcome misclassification on the rate ratio of lung cancer death per 100 fiber-years per milliliter of cumulative asbestos exposure in a cohort study of textile workers in Charleston, South Carolina, followed from 1940 to 2001. The standard covariate-adjusted estimate of the rate ratio was 1.94 (95% confidence interval: 1.55, 2.44), and modified maximum likelihood produced similar results when we assumed that the specificity of outcome classification was 0.98. With sensitivity assumed to be 0.80 and specificity assumed to be 0.95, estimated rate ratios were further from the null and less precise (rate ratio = 2.17; 95% confidence interval: 1.59, 2.98). In the present context, standard estimates for the effect of asbestos on lung cancer death were similar to estimates accounting for the limited misclassification. However, sensitivity analysis using modified maximum likelihood was needed to verify the robustness of standard estimates, and this approach will provide unbiased estimates in settings with more misclassification.
authors.forename: Jessie K
authors.initials: JK
authors.lastname: Edwards
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.forename: Haitao
authors.initials: H
authors.lastname: Chu
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Olshan
authors.forename: David B
authors.initials: DB
authors.lastname: Richardson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001194:Asbestos / Q000009:adverse effects*; D015982:Bias; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000139:chemically induced / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D016273:Occupational Exposure / Q000009:adverse effects* / Q000706:statistics & numerical data; D013022:South Carolina / Q000453:epidemiology; D013783:Textile Industry / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D001194:Asbestos
keywords: asbestos; bias; sensitivity and specificity