In former times, epidemiologists customarily published their data in a way that showed the distributions of key variables and their associations. Those days are mostly gone. From earlier papers, readers could see enough detail in the data to conduct their own analyses. This approach kept everyone informed and careful. Nowadays, it is usual for epidemiologists to present only derived results, typically from regression models, that cannot be checked from the published data. This gulf between epidemiologists and their data is conducive to publishing mistakes and obscures important information that readers should have.
The case-crossover study is designed to answer the question “Was event X triggered by something unusual that happened just before?” The key feature of the design is that each case serves as its own control. The method is analogous to a crossover experiment viewed retrospectively, except that the investigator does not control when a patient starts being exposed to a potential trigger.
The case-crossover study can also be compared with a traditional matched-pair case-control study. In both types of studies, each case has a matched control. In a traditional matched-pair case-control study, the control is a different individual at a similar time. In the matched-pair case-crossover design, the control is the same person at a different time. Decades of applied research have shown that the study design applies best when the exposure is intermittent, the effect of risk is immediate and transient, and the outcome is abrupt. Using the case-crossover design, investigators have been able to assess the extent to which episodes of physical exertion, anger, sexual activity, cocaine use, and alcohol consumption are triggers of myocardial infarctions. Others have applied the method to study triggers of other acute events including car crashes, injury, and adverse drug reactions. A placental abruption, for the most part, is an abrupt event that typically occurs in mid-to-late pregnancy; and is amenable for study using the case-crossover design.
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