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This study included cases treated surgically and nonsurgically to diminish selection bias.
However, the patients who were non-respondents and those who stopped during follow-up differed from the whole-course respondents in a number of aspects, so we used multiple imputation in order to diminish selection bias.
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Study design methods used to diminish potential selection bias included random-digit-dial to identify age-, sex- and county-matched controls from the same population from where the cases were obtained and rapid case ascertainment to identify all incident pancreatic cancer cases diagnosed in six Bay Area counties between 1994 and 1999.
9 The strength of our study lies in the large study population not selected according to medical care, thereby diminishing any selection bias.
The large sample of routinely collected data diminishes potential selection bias which may result from identification of patients in private practices, hospitals or from clinics specialised in diagnosis and treatment of sexually transmitted diseases, particularly if the identification of patients was based on a convenience sample of private practices or hospitals [ 8, 10, 11].
Unrestricted access diminishes the possibility of selection bias even further.
Along with the choice of the study design, the matching algorithm used in the current study contributed to diminishing the risk of selection bias resulting from confounding factors between groups.
One of the major strengths of this study is the fact that it was based on a larger health survey, diminishing the potential risk of selection bias.
A fourth limitation is inherent to the study design: the use of convenience sampling - as opposed to random sampling - imposes some inherent selection bias and diminishes the internal validity.
Since the CopDiff population was sampled continuously without any restrictions as to why the DIFF was requested by the GP, the risk of selection bias is diminished among these individuals.
However, selection bias can be considerably diminished in the survival analysis as only patients with known potential prognostic factors were included.
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