A simple method for analyzing matched designs with double controls: McNemar's test can be extended

Objectives: To introduce a new analytic approach for matched studies, where exactly two controls are linked to each case (double controls rather than solitary controls). The intent is to extend McNemar's test for one-to-two matching (instead of one-to-one matching) when evaluating binary predictors and outcomes.

Study design and setting: We review McNemar's approach for analyzing matched data, demonstrate the Mantel-Haenszel approach for integrating two overlapping McNemar's estimates, review conditional logistic regression as an alternative analytic approach, and introduce a new method that yields a visual display and easy verification.

Results: We illustrate the new approach with real data testing the association between overcast weather and the risk of a life-threatening traffic crash (n = 6,962). We show that results from the new approach agree closely with conditional logistic regression and are sufficiently simple as to be computed on a handheld calculator. We further validate the approach by conducting simulations when a positive association was predefined and when a null association was predefined.

Conclusion: The new approach provides a feasible, simple, and efficient method for analyzing matched designs with double controls.