alexa Design Considerations for a Two-stage Study with a Continuous Outcome and a Rare Exposure
ISSN: 2155-6180

Journal of Biometrics & Biostatistics
Open Access

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Research Article

Design Considerations for a Two-stage Study with a Continuous Outcome and a Rare Exposure

Hung-Mo Lin1* and John M. Williamson2

1Department of Health Evidence and Policy, Mount Sinai School of Medicine, New York, NY 10029, USA

2Center for Global Health Research, Centers for Disease Control and Prevention/Kenya Medical Research Institute, 1578 Kisumu-Busia Road, Kisian Kisumu, Kenya

*Corresponding Author:
Hung-Mo Lin
Department of Anesthesiology
MountSinai School of Medicine
One Gustave L. Levy Place, Box 1010
New York City, New York 10029, USA
Email: [email protected]

Received date: April 16, 2012; Accepted date: May 25, 2012; Published date: May 26, 2012

Citation: Lin HM, Williamson JM (2012) Design Considerations for a Two-stage Study with a Continuous Outcome and a Rare Exposure. J Biomet Biostat 3:144. doi: 10.4172/2155-6180.1000144

Copyright: © 2012 Lin HM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.



We consider the scenario in which the severity of a disease is characterized by a normally distributed response and the chance of being exposed (yes/no) to the risk factor is extremely rare. A screening test is employed to oversample subjects who may be at risk for the disease because expensive laboratory tests are needed to measure the outcome of interest and to confirm the true exposure status. Considerations of sample size and cost are discussed for this type of two-stage design with the objectives of 1) minimizing the number of subjects in the Stage II, and 2) overcoming the problem of a rare exposure. In particular, with an imperfect screening tool, one must take into account the sensitivity and specificity of the screening test, and the uncertainty of the estimates of the exposure prevalence in the survey population. The Penn State Children Sleep Disorder Study (PSCSDS) is used for illustration.


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