Why the study?
Does the development of coronary heart disease influence the recall of exposure to risk factors such as stress and smoking?
Cohort (n=2,550)
Does the development of coronary heart disease influence the recall of exposure to risk factors such as stress and smoking?
The study demonstrates that disease development influences recall of risk factor exposure, highlighting the potential for significant recall bias in case-control studies, particularly for psychological states.
CHD diagnosis may bias recall of smoking and stress; leaves open the extent of recall bias in case-control CHD studies.
AIMS: Case-control studies are prone to recall bias, a participant's case-control status influencing their recall of exposure to risk factors. We aimed to demonstrate empirically the scope for this bias. METHODS: Two thousand five hundred and fifty men without coronary heart disease at enrollment to a prospective cohort study underwent two health assessments, about 5 years apart. The association between the development of coronary heart disease in the intervening period and changes in reported stress and cigarette smoking were investigated. RESULTS: Men admitted to hospital with coronary heart disease reported a greater increase in psychological stress (p=0.032) and greater cessation of smoking (22% vs. 10%; p=0.007) than men not admitted. Consequently, when exposure data are collected at the end rather than at the start of the follow-up period, coronary heart disease is observed to be more strongly associated with psychological stress, and more weakly associated with smoking. CONCLUSIONS: At the time when a case-control study is conducted, levels of exposure to risk factors will have been influenced by disease development. When participants are asked about their level of exposure for a previous time period, recall is likely to be influenced by present outcome and exposure status, especially when psychological states are being investigated.
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Metcalfe et al. (2008) conducted a cohort in coronary heart disease (n=2,550). Hospital admission with coronary heart disease vs. No hospital admission with coronary heart disease was evaluated on Cessation of smoking (p=0.007).
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