Attenuation in risk estimates in logistic and Cox proportional-hazards models due to group-based exposure assessment strategy.

In occupational epidemiology, it is often possible to obtain repeated measurements of exposure from a sample of subjects (workers) who belong to exposure groups associated with different levels of exposure. Average exposures from a sample of workers can be assigned to all members of that group including those who are not sampled, leading to a group-based exposure assessment. We discuss how this group-based exposure assessment leads to approximate Berkson error model when the number of subjects with exposure measurements in each group is large, and how the error variance approximates the between-worker variability. Under the normality assumption of exposures and with moderately large number of workers in each group, there is attenuation in the estimate of the association parameter, the magnitude of which depends on the sizes of the between-worker variability and the true association parameter. Approximate equations for attenuation have been derived in logistic and Cox proportional-hazards models. These equations show that the attenuation in Cox proportional-hazards models is generally more severe than in logistic regression. Furthermore, when the between-worker variability is large, our simulation study found that the approximation by equation is poor for the Cox proportional-hazards model. If the number of subjects is small, the approximation does not hold for either model.