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To the Editor: In their case-control study of risk factors for meningococcal disease in college students, Dr Bruce and colleagues¹ report that 4 of the case subjects (8%) died before exposure histories could be obtained, so proxy patients were interviewed. The authors did not exclude the 4 deceased case subjects, nor did they identify and interview proxies of the 4 matched controls. It is possible that this introduced a small amount of bias because of the differential misclassification of exposure. The case subjects were more likely than the control subjects to have had their exposures misclassified. The odds ratios (ORs) may have been biased toward or away from the null value.² For example, the lack of a significant association between active smoking and risk of disease may have been caused by underreporting by the 4 proxy patients.

Since the case-fatality rate of meningococcal disease in adolescents and young adults may . . . [Full Text of this Article]

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RELATED ARTICLE

Risk Factors for Meningococcal Disease in College Students
Michael G. Bruce, Nancy E. Rosenstein, Jennifer M. Capparella, Kathleen A. Shutt, Bradley A. Perkins, and MarJeanne Collins
JAMA. 2001;286(6):688-693.
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