The lack of selection bias in a snowball sampled case-control study on drug abuse

Background. Friend controls in matched case-control studies can be a potential source of selection bias based on the assumption that friends are more likely to share exposure factors. This study evaluates the role of selection bias in a case-control study that used the snowball sampling method based on friendship for the selection of cases and controls. Methods. The cases selected for the study were drug abusers located in the community. Exposure was defined by the presence of at least one psychiatric diagnosis. Psychiatric and drug abuse/dependence diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria. Cases and controls were matched on sex, age and friendship. The measurement of selection bias was made through the comparison of the proportion of exposed controls selected by exposed cases (pi) with the proportion of exposed controls selected by unexposed cases (p2). If p1 = p2, then, selection bias should not occur. Results. The observed distribution of the 185 matched pairs having at least one psychiatric disorder showed a pi value of 0.52 and a p2 value of 0.51, indicating no selection bias in this study. Conclusion. Our findings support the idea that the use of friend controls can produce a valid basis for a case-control study.