Healthy user bias
 | This article relies on a single source. (September 2025) |
The healthy user bias or healthy worker bias is a bias that can damage the validity of epidemiologic studies testing the efficacy of particular therapies or interventions.
Specifically, it is a sampling bias or selection bias. For example, in trials or experimental studies, the subjects that take up an intervention (e.g by enrolling in a clinical trial), are not representative of the general population in terms of their health status. Subjects who volunteer for a study can be expected, on average, to be healthier than people who don't volunteer, as they are concerned for their health and are predisposed to follow medical advice,[1] both factors that would aid one's health.
In occupational epidemiological studies, being healthy or engaging in health-promoting activities may lead to different employment opportunities or longer employment histories. Where recruitment into such studies is conditioned on length of employment (e.g. excluding temporary workers or those who leave employment before a certain period of time has elapsed), it may also be conditioned inadvertently on health. For example, someone in ill health is unlikely to have a job as manual laborer. As a result, studies of manual laborers are studies of people who are currently healthy enough to engage in manual labor, rather than studies of people who would do manual labor if they were healthy enough.[citation needed] In a cohort study of French uranium enrichment workers, a strong healthy worker effect was observed when their mortality was compared to that of the general population: nuclear workers are typically recruited subject to health screening and are undergo regular health checks throughout their employment, leading to selection of healthy workers.[2]
References
[edit]- ↑ Shrank, William H.; Patrick, Amanda R.; Alan Brookhart, M. (May 2011). "Healthy User and Related Biases in Observational Studies of Preventive Interventions: A Primer for Physicians". Journal of General Internal Medicine. 26 (5): 546–550. doi:10.1007/s11606-010-1609-1. ISSN 0884-8734. PMC 3077477. PMID 21203857.
- ↑ Zhivin, S., Guseva Canu, I., Samson, E., Laurent, O., Grellier, J., Collomb, P., Zablotska, L. B., Laurier, D. (2015). "Mortality (1968–2008) in a French cohort of uranium enrichment workers potentially exposed to rapidly soluble uranium compounds". Occupational and Environmental Medicine.
Further reading
[edit]- Li, C. -Y.; Sung, F. -C. (1999). "A review of the healthy worker effect in occupational epidemiology". Occupational Medicine. 49 (4): 225–9. doi:10.1093/occmed/49.4.225. PMID 10474913.
- Fornalski, K. W.; Dobrzyński, L. (2010). "The Healthy Worker Effect and Nuclear Industry Workers". Dose-Response. 8 (2): 125–147. doi:10.2203/dose-response.09-019.Fornalski. PMC 2889508. PMID 20585442.
- McMichael, A. J. (1976). Standardized mortality ratios and the “healthy worker effect”: Scratching beneath the surface. Journal of Occupational Medicine, 18, 165–168. doi:10.1097/00043764-197603000-00009
- Tabuchi T., Nakayama T., Fukushima W., Matsunaga I., Ohfuji S., Kondo K., Oshima A. (2015). "Determinants of participation in prostate cancer screening: A simple analytical framework to account for healthy-user bias". Cancer Science. 106 (1): 108–114. doi:10.1111/cas.12561. PMC 4317786. PMID 25456306.
{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: unflagged free DOI (link)
