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Because the definition of gout was based on doctors' diagnoses, a certain level of misclassification of use is inevitable.
This was done to minimise misclassification of use among people who received but did not fill the prescription or take the drug.
For example, we assessed the potential misclassification of use by redefining exposure as receiving two prescriptions for therapy within a 3-month period, and redefining new user as requiring a therapy-free baseline period of 1 year.
First, data on households that use a combination of solid and non-solid fuels were not available from the NDHS database, and misclassification of use of cooking fuels may have occurred.
Analyses repeated on this group of patients obtained similar results, which suggests that any misclassification of use of medication because of over-the-counter purchase is not an explanation for our findings.
In a second sensitivity analysis we assessed potential misclassification of use by redefining ever use of pioglitazone and rosiglitazone as receiving at least three prescriptions within a 12 month period, thus minimising the inclusion of patients who may not have been regular users or used these drugs sporadically.
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Because the prescription data are prospectively recorded, any misclassification of NSAID use due to nonadherence or OTC use of aspirin or ibuprofen would generally bias measures of associations towards the null.
Yet, nondifferential misclassification of drug use due to noncompliance or OTC use would tend to attenuate the true association between the specific drug group and breast cancer (Ulcickas Yood et al, 2000).
None the less, we did observe a significant relation between duration of PPI use and risk of hip fracture; any misclassification of PPI use before 2000 would be expected to attenuate our risk estimates.
With repeated measurements of aspirin use we account for changes in aspirin exposure over time and reduce the potential for misclassification of aspirin use.
Another limitation is the potential misclassification of bisphosphonate use.
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