Spectrum bias
In
specificity and it is changes in these that are considered when referring to spectrum bias. However, other performance measures such as the likelihood ratios may also be affected by spectrum bias.[2]
Generally spectrum bias is considered to have three causes.specificity.[4] This final cause is not widely appreciated, but there is mounting empirical evidence[4][5] as well as theoretical arguments[6] which suggest that it does indeed affect a test's performance.
Examples where the
specificity change between different sub-groups of patients may be found with the carcinoembryonic antigen test[7] and urinary dipstick tests.[8]
Diagnostic test performances reported by some studies may be artificially overestimated if it is a case-control design where a healthy population ('fittest of the fit') is compared with a population with advanced disease ('sickest of the sick'); that is two extreme populations are compared, rather than typical healthy and diseased populations.[9]
If properly analyzed, recognition of
heterogeneity of subgroups can lead to insights about the test's performance in varying populations.[3]
See also
- Simpson's paradox
- Biased sample
- Reporting bias
- Reference class problem
References
- PMID 692598.
- ^ PMID 18765409.
- ^ S2CID 35752032.
- ^ PMID 22307105.
- ^ Leeflang MM, Bossuyt PM, Irwig L., Diagnostic test accuracy may vary with prevalence: implications for evidence-based diagnosis, J Clin Epidemiol. 2009 Jan;62(1) 5–12.
- S2CID 24636826.
- PMID 3510056.
- S2CID 25381473.
- ^ Rutjes AWS, Reitsma JB, Vandenbroucke JP, Glas AS, Bossuyt PMM, Case-control and two-gate designs in diagnostic accuracy studies, Clin Chem 2005;51(8):1335–41.
