Information Bias (Observation Bias)
From the previous section it should be clear that, even if the categorization of subjects regarding exposure and outcome is perfectly accurate, bias can be introduced differential selection or retention in a study. The converse is also true: even if the selection and retention into the study is a fair representation of the population from which the samples were drawn, the estimate of association can be biased if subjects are incorrectly categorized with respect to their exposure status or outcome. These errors are often referred to as misclassification, and the mechanism that produces these errors can result in either non-differential or differential misclassification. Ken Rothmantext annotation indicator distinguishes these as follows:
"For exposure misclassification, the misclassification is nondifferential if it is unrelated to the occurrence or presence of disease; if the misclassification of exposure is different for those with and without disease, it is differential. Similarly, misclassification of disease [outcome] is nondifferential if it is unrelated to the exposure; otherwise, it is differential."
Nondifferential Misclassification of Exposure
Nondifferential misclassification means that the frequency of errors is approximately the same in the groups being compared. Misclassification of exposure status is more of a problem than misclassification of outcome (as explained on page 6), but a study may be biased by misclassification of either exposure status, or outcome status, or both.
Nondifferential misclassification of a dichotomous exposure occurs when errors in classification occur to the same degree regardless of outcome. Nondifferential misclassification of exposure is a much more pervasive problem than differential misclassification (in which errors occur with greater frequency in one of the study groups). The figure below illustrates a hypothetical study in which all subjects are correctly classified with respect to outcome, but some of the exposed subjects in each outcome group were incorrectly classified as 'non-exposed.'