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Bias and Confounding: Nayana Fernando

This document discusses bias, confounding, and methods to control for them in statistical analyses. It defines bias as systematic error in a study's design, methods, or analysis that distorts results. Confounding occurs when an extraneous variable is associated with both the exposure and outcome under study. The document outlines various types of bias like selection, information, and Berksonian bias. It also discusses methods to control for bias and confounding like randomization, restriction, matching, stratification, and adjustment during study design and analysis.

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210 views31 pages

Bias and Confounding: Nayana Fernando

This document discusses bias, confounding, and methods to control for them in statistical analyses. It defines bias as systematic error in a study's design, methods, or analysis that distorts results. Confounding occurs when an extraneous variable is associated with both the exposure and outcome under study. The document outlines various types of bias like selection, information, and Berksonian bias. It also discusses methods to control for bias and confounding like randomization, restriction, matching, stratification, and adjustment during study design and analysis.

Uploaded by

anoj
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Bias and Confounding

Nayana Fernando

To Show a Valid Statistical Association


We need to assess:

Bias: whether systematic error has


been built into the study design

Confounding: whether an extraneous


factor is related to both the disease
and the exposure

Role of chance: how likely is it that


what we found is a true finding

BIAS
Systematic, non-random deviation of
results and inferences from the truth, or
processes leading to such deviation. Any
trend in the collection, analysis,
interpretation, publication or review of
data that can lead to conclusions which
are systematically different from the truth.
(Dictionary of Epidemiology, 3rd ed.)

BIAS
Systematic error built into the
study design
Selection Bias
Information Bias

For example:

Babies who are breast-fed have less illness


than babies who are bottle-fed.

Which illnesses? How is feeding type


defined?How large a difference in risk?
A better example:
Babies who are exclusively breast-fed for
three months or more will have a reduction in
the incidence of hospital admissions for
gastroenteritis of at least 30% over the first
year of life.

Selection bias
statisticalbiasin which there is an
error in choosing the individuals or
groups to take part in a scientific
study. It is sometimes referred to as
theselectioneffect.
Bias resulting from the method of
collecting samples

Types of Selection Bias


Sampling bias
Time interval bias

Types of Selection Bias (cont.)


Response Bias those who agree to
be in a study may be in some way
different from those who refuse to
participate
Volunteers may be different from
those who are enlisted

Healthy worker effect


A phenomenon observed initially in
studies of occupational diseases:
workers usually exhibit lower overall
death rates than the general
population, because the severely ill
and chronically disabled are
ordinarily excluded from
employment. Death rates in the
general population may be
inappropriate for comparison if this
effect is not taken into account.

Example. healthy worker


effect
Question: association b/w
formaldehyde exposure and eye
irritation
Subjects: factory workers exposed
to formaldehyde
Bias: those who suffer most from
eye irritation are likely to leave the
job at their own request or on
medical advice
Result: remaining workers are less

Information Bias (cont.)


Misclassification bias errors are
made in classifying either disease or
exposure status

Berksonian bias

There may
be a spurious association
between diseases or between a
characteristic and a disease
because of the different
probabilities of admission to a
hospital for those with the
disease, without the disease and
with the characteristic of
interest

Example: Misclassification bias

1.
2.
3.
.
.

Subjects: hospital cases under the care of


a physician
Excluded:
Die before admission acute/severe
disease.
Not sick enough to require hospital care
Do not have access due to cost, distance
etc.
Result: conclusions cannot be generalized
Also known as Ascertainment Bias

Types of Information Bias


Interviewer Bias an interviewers
knowledge may influence the structure
of questions and the manner of
presentation, which may influence
responses

Recall Bias those with a particular


outcome or exposure may remember
events more clearly or amplify their

Types of Information Bias (cont.)


Observer Bias observers may have
preconceived expectations of what they
should find in an examination

Loss to follow-up those that are lost


to follow-up or who withdraw from the
study may be different from those who
are followed for the entire study

Information Bias (cont.)

Hawthorne effect an effect first


documented at a Hawthorne
manufacturing plant; people act
differently if they know they are
being watched

Surveillance bias the group with


the known exposure or outcome may
be followed more closely or longer
than the comparison group

Controls for Bias


Be purposeful in the study design to minimize the
chance for bias
Example: use more than one control group

Define, a priori, who is a case or what constitutes


exposure so that there is no overlap
Define categories within groups clearly (age groups, aggregates
of person years)

Set up strict guidelines for data collection


Train observers or interviewers to obtain data in the same fashion
It is preferable to use more than one observer or interviewer, but
not so many that they cannot be trained in an identical manner

Controls for Bias (cont)


Randomly allocate observers/interviewer data
collection assignments
Institute a blinding process if appropriate
Single blind study subjects are unaware of whether
they are in the experimental or control group
Double blind study the subject and the observer are
unaware of the subjects group allocation
Triple blind study the subject, observer and data
analyst are unaware of the subjects group allocation

Build in methods to minimize loss to follow-up

Confounding
When another exposure exists in the
study population (besides the one
being studied) and is associated both
with disease and the exposure being
studied. If this extraneous factor
itself a determinant of or risk factor
for health outcome is unequally
distributed b/w the exposure
subgroups, it can lead to confounding
(Beaglehole)

Confounder must be
1. Risk factor among the unexposed
(itself a determinant of disease)
2. Associated with the exposure
under study
3. Unequally distributed among the
exposed and the unexposed groups

The difference between bias and


confounding

Bias creates an association that is


not true, but confounding describes
an association that is true, but
potentially misleading.

Examples confounding

COFFEE DRINKING

HEART DISEASE

(Smoking increases
the risk of heart ds

Coffee drinkers are


more likely to smoke)

SMOKING

Examples confounding
ALCOHOL
INTAKE

MYOCARDIAL
INFARCTION

(Men are more likely


to consume alcohol
than women)

(Men are more at risk


for MI)

SEX

Methods for controlling


Selection Bias
During Study Design
1. Randomization
2. Restriction
3. Matching
During analysis
4. Stratification
5. Adjustment
a) Simple / standardization
b) Multiple / multivariate adjustment
c) Best case / worst case analysis

Restriction
Subjects chosen for study are
restricted to only those possessing
a narrow range of characteristics,
to equalize important extraneous
factors
Limitation: generalisability is
compromised; by excluding
potential subjects, cohorts / groups
selected may be unusual and not
representative of most patients or

Example restriction
Study: effect of age on prognosis
of MI
Restriction: Male / White /
Uncomplicated anterior wall MI
Important extraneous factors
controlled for: sex / race / severity
of disease
Limitation: results not
generalizable to females, people of

Example restriction
OCP example
restrict study to women having at
least one child
Colorectal cancer example
restrict patients to a particular
staging of Dukes classification

Matching - definition
The process of making a study group
and a comparison group comparable
with respect to extraneous factors
(Last)

For each patient in one group there


are one or more patients in the
comparison group with same
characteristics, except for the factor
of interest
(Fletcher)

Matching is often done for age, sex,


race, place of residence, severity of
disease, rate of progression of
disease, previous treatment received
etc.
Limitations:
- controls for bias for only those factors
involved in the match
- Usually not possible to match for more
than a few factors because of the
practical difficulties of finding patients
that meet all matching criteria
- If categories for matching are
relatively crude, there may be room

Example Matching
Study: ? Association of Sickle cell trait
(HbAS) with defects in physical growth
and cognitive development
Other potential biasing factors: race,
sex, birth date, birth weight, gestational
age, 5-min Apgar score, socio economic
status
Solution: matching for each child with
HbAS selected a child with HbAA who
was similar with respect to the seven
other factors (50+50=100)

Stratification
The process of or the result of
separating a sample into several
sub-samples according to specified
criteria such as age groups, socioeconomic status etc.
(Last)

The effect of confounding variables


may be controlled by stratifying
the analysis of results
After data are collected, they can
be analyzed and results presented
according to subgroups of patients,

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