Reducing Bias Due to Exposure Measurement Error Using Disease Risk Scores

Suppose that an investigator wants to estimate an association between a continuous exposure variable and an outcome, adjusting for a set of confounders. If the exposure variable suffers classical measurement error, in which the measured exposures are distributed with independent error around the true exposure, then an estimate of the covariate-adjusted exposure-outcome association may be biased. We propose an approach to estimate a marginal exposure-outcome association in the setting of classical exposure measurement error using a disease score-based approach to standardization to the exposed sample. First, we show that the proposed marginal estimate of the exposure-outcome association will suffer less bias due to classical measurement error than the covariate-conditional estimate of association when the covariates are predictors of exposure. Second, we show that if an exposure validation study is available with which to assess exposure measurement error then the proposed marginal estimate of the exposure-outcome association can be corrected for measurement error more efficiently than the covariate-conditional estimate of association. We illustrate both of these points using simulations and an empirical example using data from the Orinda Longitudinal Study of Myopia (1989-2001).