Invited Commentary: Ecologic Studies—Biases, Misconceptions, and Counterexamples

Many authors have pointed out that relative-risk estimates derived from ecologic data are vulnerable to biases not found in estimates derived from individual-level data. Nevertheless, biases in ecologic studies still are often dealt with in the same manner as biases in other observational studies, and so are not given adequate treatment. This commentary reviews and illustrates some of the more recent findings about bias in ecologic estimates. Special attention is given to problems of ecologic confounder control when individual risks follow a nonlinear model, and to misconceptions about ecologic bias that have appeared in the literature.