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Understanding Confounding in Epidemiologic Studies: Prevention, Evaluation, and Control, Slides of Public Health

An in-depth exploration of confounding in epidemiologic studies. It covers the concept of confounding, methods to prevent and evaluate it, and the criteria for confounding. The document also discusses various methods for controlling confounding, including matching, restriction, and randomization, and evaluating confounding through stratified analysis and multivariate analysis.

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2012/2013

Uploaded on 11/21/2013

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IV.
Potential Errors In
Epidemiologic Studies
Confounding
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Potential Errors InEpidemiologic StudiesIV.^ Confoundingdocsity.com

LearningObjectives • Understand^ the^ concept

of

confounding • Recognize^ the

methods^ to

prevent confounding • Know the methods to evaluatethe impact of confoundingdocsity.com

ConfoundingA situation in which effectsof two^ risk^ factors

are mixed in the occurrence ofthe health problem understudydocsity.com

Confounding^

may^ lead^ to

overestimation^

or^ under-

estimation^ of

the^ true

association^ between

exposure

and^ outcome^

and^ can^ even

change^ the^ direction

of^ the

observed effectdocsity.com

Control ofConfounding Prevent^ Study^ Evaluatedocsity.com

Prevention ofConfounding^ Matching Restriction^ Randomizationdocsity.com

RestrictionStrength •Straightforward•Convenient if criteria arenarrow•Inexpensivedocsity.com

RestrictionLimitation • Reduces the number of subjectseligible to participate • Difficult if criteria are not narrow • Does not permit evaluation ofassociation between exposure andoutcome for varying levels offactordocsity.com

RandomizationStrength • Controls confounders even thoseunsuspected • Study groups are comparable • Permits evaluation of

association between exposure and outcome forvarying levels of the factordocsity.com

RandomizationLimitation • Not easy to perform • Ethical problems • Expensivedocsity.com

MatchingStrength • Appropriate when sample sizeis small^ and^ matchingvariables are limited • Study groups are comparabledocsity.com

MatchingLimitation • Difficult, expensive and timeconsuming to find comparisonsubjects • Matching on a particularvariable prohibits studying itsassociation with the outcomedocsity.com

Stratified AnalysisStratification^ is^

a^ technique used to control confounding inthe analysis stage that involvesthe evaluation of the associationwithin homogeneous categoriesor^ strata^ of^ the

confounding factordocsity.com

StratificationStrength • Easy for limited variables withlimited number of categories • Permits evaluation of confoundingand interaction • Permits evaluation of associationbetween exposure and outcome forvarying levels of the factordocsity.com