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Regional variation in diagnostic practice and reporting was a possible source of misclassification, which may be related to exposure levels, because we based the exposure contrasts on regional differences.
Leptin levels were determined on nonfasting blood samples, and diurnal variations in concentrations may result in random misclassification, which may have biased our results toward the null hypothesis of no association between leptin and the outcomes evaluated.
However, urinary BPA concentrations were relatively low in our study population, enhancing the analytical uncertainties and hence the potential for exposure misclassification, which may limit our ability to distinguish monotonic from nonmonotonic associations.
Though hospital data are routinely used for surveillance in Québec [ 16], validation of diagnostic (or procedure) codes has not been undertaken, and results should be interpreted in light of probable non-differential misclassification which may have attenuated associations.
Despite high positive and negative predictive value of self-reported diabetes in WHI, this may result in some degree of exposure misclassification, which may have led us to underestimate the strength of the association we observed.
Fetal growth after 41 weeks gestation could have resulted in a baby being classified in a different growth category (e.g. AGA) than he/she would have been at 41 weeks (e.g., SGA); however any minor misclassification which may have resulted from this approach was deemed preferable to eliminating these records.
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Depending on when measures are obtained, exposure misclassification is possible, which may influence the directionality of observed interactions.
Doing so, we eliminated differential misclassification of BMI, which may have biased other studies 13 16 because underweight people tend to overestimate their BMI and overweight people tend to underestimate their BMI.
In addition, despite the generally high agreement between the enzyme-linked immunoassay and immunohistochemical techniques, differences in classification as well as interlaboratory variation may result in misclassification, which, if present, may have also attenuated the true association.
32 39 40 This could lead to misclassification of the exposure, which may result in an underestimation or overestimation of the association.
We did not explore misclassification by vertical elevation which may contribute error if air pollutant exposure profiles are found to change as elevation increases.
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