The Use of Deceased Controls in Epidemiologic Research: A Systematic Review

Abstract

Scholarly debate on the use of deceased controls in epidemiologic research continues. This systematic review examined published epidemiologic research using deceased persons as a control group. A systematic search of 5 major biomedical literature databases (MEDLINE, CINAHL, PsycINFO, Scopus, and EMBASE) was conducted, using variations of the search terms "deceased" and "controls" to identify relevant peer-reviewed journal articles. Information was sought on study design, rationale for using deceased controls, application of theoretical principles of control selection, and discussion of the use of deceased controls. The review identified 134 studies using deceased controls published in English between 1978 and 2015. Common health outcomes under investigation included cancer (n=31; 23.1%), nervous system diseases (n=26; 19.4%), and injury and other external causes (n=22; 16.4%). The majority of studies used deceased controls for comparison with deceased cases (n=95; 70.9%). Investigators rarely presented their rationale for control selection (n=25/134; 18.7%); however, common reasons included comparability of information on exposures, lack of appropriate controls from other sources, and counteracting bias associated with living controls. Comparable accuracy was the most frequently observed principle of control selection (n=92; 68.7%). This review highlights the breadth of research using deceased controls and indicates their appropriateness in studies using deceased cases.