An age dependent stochastic model of periodic screening: Length bias at a prevalence screen (Q800845)

An age dependent stochastic model for the periodic screening of a progressive chronic disease is used to investigate the length bias phenomenon for the case of a single screen. The preclinical state sojourn time distribution is obtained for control group cases, cases detected at the screen, and interval cases which surface after the screen in the screened group within an evaluation trial setting. Properties of these distributions are compared among themselves and with those of the underlying population to investigate the magnitude and direction of the length bias. The effect upon length bias of the magnitude of the false negative probability, the length of followup, the age at screening, the variance of the preclinical state sojourn time, and the correlation between the sojourn times in the disease free and preclinical disease states are investigated. Numerical results indicate that certain combinations of correlation and age at screening can result in substantial length bias in either the positive or the negative direction. It is also apparent that use of the randomized trial design and a suitable age range for screening can help to eliminate most of the extreme or negative length bias effects.