Erratum: Sensitivity to Biases of Case-Control Studies on Medical Procedures, Particularly Surgery and Blood Transfusion, and Risk of Creutzfeldt-Jakob Disease

Background: Evidence of risk of Creutzfeldt-Jakob disease (CJD) associated with medical procedures, including surgery and blood transfusion, is limited by susceptibility to bias in epidemiological studies. Methods: Sensitivity to bias was explored using a central-birth-cohort model using data from 18 case-control studies obtained after a review of 494 reports on medical procedures and risk of CJD, systematic for the period January 1, 1989 to December 31, 2011. Results: The validity of the findings in these studies may have been undermined by: recall; control selection; exposure assessment in life-time periods of different duration, out of time-at-risk of effect, or asymmetry in case/control data; and confounding by concomitant blood transfusion at the time of surgery. For sporadic CJD (sCJD), a history of surgery or blood transfusion was associated with risk in some, but not all, recent studies at a ≥10 year lag time, when controls were longitudinally sampled. Space-time aggregation of surgical events was not seen. Surgery at early clinical onset might be overrepresented among cases. Neither surgical history nor blood transfusion unlabelled for donor status, dental treatments or endoscopic examinations were linked to variant CJD (vCJD). Conclusions: These results indicate the need for further research. Common challenges within these studies include access to and content of past medical/dental treatment records for diseases with long incubation periods.

背景：与手术、输血等医疗操作相关的克雅氏病（Creutzfeldt-Jakob disease, CJD）风险证据，常因流行病学研究易受偏倚影响而存在局限性。方法：本研究针对1989年1月1日至2011年12月31日期间发表的494篇关于医疗操作与克雅氏病风险的报告开展系统回顾，经筛选纳入18项病例对照研究的数据，采用中心出生队列模型对偏倚敏感性展开分析。结果：上述研究的结论效度可能受以下因素削弱：回忆偏倚、对照选择偏倚、不同时长的终生暴露期评估偏差（暴露时间未处于效应风险窗口期内）、病例对照数据不对称，以及手术同期输血引发的混杂偏倚。对于散发性克雅氏病（sporadic CJD, sCJD），部分（而非全部）近期研究显示，当采用纵向抽样选取对照且滞后时间≥10年时，手术或输血史与发病风险存在关联。未观察到手术事件的时空聚集性。临床发病早期接受手术的病例可能在研究中被过度代表。手术史、未标注供体状态的输血史、牙科治疗或内镜检查，均与变异型克雅氏病（variant CJD, vCJD）无关联。结论：本研究结果提示仍需开展进一步相关研究。此类研究普遍面临的共性挑战包括：针对潜伏期较长的疾病，难以获取完整的既往医疗及牙科治疗记录，且此类记录的内容质量参差不齐。