In occupational epidemiology, workers often show lower overall mortality than the general population simply because severely ill and disabled individuals are less likely to be employed. When this artifact makes an occupational exposure appear protective, the phenomenon is termed:
- A Berkson's bias
- B Neyman's bias
- C Healthy worker effect ✓
- D Hawthorne effect
Correct answer: C. Healthy worker effect
Explanation
The healthy worker effect is a form of selection bias arising because employment itself selects for better health. Comparing worker mortality against general population rates therefore biases results toward showing lower risk in the exposed group, potentially masking true hazards. Berkson's bias concerns hospital-based control selection, Neyman's bias concerns survival into prevalence studies, and the Hawthorne effect concerns behavior change under observation.
Reference: Park's Textbook of Preventive and Social Medicine, 27th ed.
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