Expected final online publication date for the Annual Review of Public Health Volume 29 is March 17, 2008. Please see for revised estimates.


Ecologic studies use data aggregated over groups, rather than data on individuals. Such studies are popular since they may make use of existing data bases, and can offer large exposure variation if based on broad geographical areas. Unfortunately the aggregation of data that defines ecologic studies results in a loss of information that can lead to ecologic bias. Specifically, ecologic bias arises from the inability of ecologic data to characterize within-area variability in exposures and confounders. We describe in detail particular forms of ecologic bias so that their potential impact on any particular study may be assessed. The only way to overcome such bias, while avoiding uncheckable assumptions concerning the missing information, is to supplement the ecologic with individual-level information, and we outline a number of proposals that have been suggested to achieve this aim.



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