Public health policy and practice
What is the "golden standard" for assessing population-based
interventions?
problems of dilution bias
L Lindholma, M Roséna b
a Department of Public
Health and Clinical Medicine, Umeå University, Umeå, Sweden, b Centre for
Epidemiology, National Board of Health and Welfare, Stockholm, Sweden
Correspondence to: Dr Rosén, Centre for Epidemiology, National Board of Health and Welfare, S-106 30 Stockholm, Sweden (mans.rosen{at}sos.se)
Accepted for publication 12 January 2000
OBJECTIVES
To identify
different types of dilution bias in population-based interventions and
to suggest measures for handling these methodological problems.
DESIGNLiterature
review plus analysis of data from a population-based intervention
against cardiovascular disease in a Swedish municipality.
MAIN RESULTSThe
effects of an intervention on mortality and morbidity were much more
diluted by non-intervening factors, dissemination to areas outside the
intervention area, social diffusion, population mobility and time than
by using intermediate outcome measures.
CONCLUSIONSTheoretically,
changes in scientifically well documented risk factors, for example,
intermediate outcome measures, should be preferred to using morbidity
or mortality as outcome measures.
Keywords: population-based interventions
© 2000 by Journal of Epidemiology and Community Health
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