Correcting for bias in relative risk estimates due to exposure measurement error: A case study of occupational exposure to antineoplastics in pharmacists

Objectives. This paper describes 2 statistical methods designed to correct for bias from exposure measurement error in point and interval estimates of relative risk. Methods. The first method takes the usual point and interval estimates of the log relative risk obtained from logistic regression and corrects them for nondifferential measurement error using an exposure measurement error model estimated from validation data. The second, likelihood-based method fits an arbitrary measurement error model suitable for the data at hand and then derives the model for the outcome of interest. Results. Data from Valanis and colleagues' study of the health effects of antineoplastics exposure among hospital pharmacists were used to estimate the prevalence ratio of fever in the previous 3 months from this exposure. For an interdecile increase in weekly number of drags mixed, the prevalence ratio, adjusted for confounding, changed from 1.06 to 1.17 (95% confidence interval [CI] = 1.04, 1.26) after correction for exposure measurement error. Conclusions. Exposure measurement error is often an important source of bias in public health research. Methods are available to correct such biases.