Nested case–control study: Difference between revisions

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A '''nested case control (NCC) study''' is a variation of a [[case-control study]] in which only a subset of controls from the cohort are compared to the incident cases. In a case-control study, all incident cases in the cohort are compared to a random subset of participants who do not develop the disease of interest. In contrast, in a nested-case-control study, some number of controls are selected for each case from that case's matched risk set. By matching on factors such as age and selecting controls from relevant risk sets, the nested case control model is generally more efficient than a case-cohort design with the same number of selected controls.

Usually, the exposure of interest is only measured among the cases and the selected controls. Thus the nested case control study is less efficient than the full cohort design. The nested case control study can be analyzed using methods for missing covariates.<ref name=Cai/>

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==Example==

As an example, of the 91,523 women in the [[Nurses' Health Study]] who did not have cancer at baseline and who were followed for 14 years, 2,341 women had developed breast cancer by 1993. Several studies have used standard cohort analyses to study precursors to breast cancer, e.g. use of hormonal contraceptives,<ref name="pmid9051324">{{cite journal| authorauthor1=Hankinson SE, |author2=Colditz GA, |author3=Manson JE, |author4=Willett WC, |author5=Hunter DJ, |author6=Stampfer MJ et al. | title=A prospective study of oral contraceptive use and risk of breast cancer (Nurses' Health Study, United States). | journal=Cancer Causes Control | year= 1997 | volume= 8 | issue= 1 | pages= 65-7265–72 | pmid=9051324 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9051324 }} </ref> which is a covariate easily measured on all of the women in the cohort. However, note that in comparison to the cases, there are so many controls that each particular control contributes relatively little information to the analysis.

If, on the other hand, one is interested in the association between [[gene expression]] and breast cancer incidence, it would be very expensive and possibly wasteful of precious blood specimen to assay all 89,000 women without breast cancer. In this situation, one may choose to assay all of the cases, and also, for each case, select a certain number of women to assay from the risk set of participants who have not yet failed (i.e. those who have not developed breast cancer before the particular case in question has developed breast cancer). The risk set is often restricted to those participants who are matched to the case on variables such as age, which reduces the variability of effect estimates.