Confounding Flashcards
Magnitude of confounding equation
= (RR crude - RR adjusted) / RR adjusted
confounding definition
the mixing of effects between an exposure, an outcome, and a 3rd extraneous variable
Positive confounding
True RR is 1.0, confounded RR is 2.0
Negative confounding
True RR is 3.0, confounded RR is 2.0
confounding by indication
treatments are given to individuals with a particular disease, therefore a mixing of effects between the treatment, the disease for which the treatment is given, and the outcome under study
confounding by severity
the severity of the disease is the potential confounder
makes the therapy appear less effective in obs studies compared to exp studies
3 main ways to control confounding in the design stage
randomization, restriction(limiting who may participate in the study) BUT makes difficult to find subjects and limits generalizability, matching (making study and comparison groups similar w/respect to extraneous factors) BUT is expensive, can overmatch
3 main ways to control confounders in analysis stage
standardization, stratification, and multivariate methods
Residual confounding
confounding that remains even after many confounding variables have been controlled
may arise from uncollected data, persistent differences in risk within a category of a confounder, and when the confounder is misclassified
Effect measure modification
change in the strength of an association between an exposure and disease according to the level of a 3rd variable
3 criteria that need to be fulfilled to be a potential confounder
variable needs to be associated with the exposure
variable needs to be associated with the outcome/disease
variable is not an intermediate in causal pathway between exposure and outcome
What is the purpose of controlling for confounding?
to get a more precise estimate of the true association between the exposure and the disease/outcome
what 3 aspects of a study must be evaluated before declaring a statistical association?
confounding/effect modification, bias, stratified significance