Berkson's bias most commonly threatens the validity of which study design?
- A Hospital-based case-control study ✓
- B Population-based cohort study
- C Randomized controlled trial
- D Cross-sectional survey using random sampling
Correct answer: A. Hospital-based case-control study
Explanation
Berkson's bias (admission rate bias) occurs when cases and controls are both drawn from a hospital population rather than the community. Hospital patients with two conditions (disease + exposure) are differentially more likely to be admitted than those with either condition alone, creating a spurious association or masking a true one. This is an inherent risk in hospital-based case-control studies. Population-based cohort studies and RCTs with community recruitment are less susceptible.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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