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Sex Transm Dis. 2019 Jan;46(1):e5-e7. doi: 10.1097/OLQ.0000000000000911.

Risk Factor Reversal in Studies of Infectious Disease: Making Counterintuitive Results Intuitive Again.

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From the Department of Epidemiology, Biostatistics, and Occupational Health McGill University, Montreal, QC, Canada.
Department of Epidemiology and Environmental Health School of Public Health and Health Professions University at Buffalo, The State University of New York, Buffalo, NY.
Department of Epidemiology Brown University School of Public Health, Providence, RI, and.
Department of Family Medicine and Community Health University of Minnesota, Minneapolis, MN.


A previously published study reported the seemingly paradoxical finding that men who have sex with men status was strongly protective and recent sexual abstinence strongly deleterious in relation to mortality prognosis. We explain why these results are entirely logical and that the counterintuitive direction of the effects derives from the comparison group implied by the study design.

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