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In Reply. —Dr DiFerdinando identifies methodologic issues that do not invalidate the association between incarceration and TB. Incomplete ascertainment of TB cases constitutes a misclassification of diseased patients as healthy. Nondifferential misclassifications bias epidemiologic studies to the null hypothesis, which means that the true association is stronger than that observed. The use of "time in jail" to measure the association of time in jail with TB is perfectly valid. The measure encompasses all the time a subject was remanded to the department of corrections, including central booking, holding pens, and receiving rooms. It is not merely time spent on Rikers Island. While it would be useful to have a detailed breakdown of this experience, this was beyond the scope of our study. Conceivably, specific aspects of incarceration carry an even higher risk of developing TB than we found when looking at incarceration in the aggregate. The concern that the time |
