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‘Depletion of the susceptibles’ taught through a story, a table and basic arithmetic
  1. Steven D Stovitz1,
  2. Hailey R Banack2,
  3. Jay S Kaufman3
  1. 1 Family Medicine and Community Health, University of Minnesota System, Minneapolis, Minnesota, USA
  2. 2 Epidemiology and Environmental Health, University at Buffalo–The State University of New York, Buffalo, New York, USA
  3. 3 Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
  1. Correspondence to Dr Steven D Stovitz, Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN 55455, USA; stovitz{at}umn.edu

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‘Depletion of the susceptibles’ is a phrase occasionally used to describe a form of selection bias where harmful exposures can appear protective.1 2 This bias, which affects evidence interpretation, may be difficult for clinicians to recognise, because study participants may represent a random sample of people similar to a clinician’s patients. In this letter, we explain the bias through a story, a table and basic arithmetic to help those unfamiliar with other explanations using hazard ratios,3 inverse probability weighting4 or directed acyclic graphs conditioning on survival.5

Imagine a …

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