ConfoundingInteraction混杂0 0interaction.pptVIP

Confounding And Interaction Dr. L. Jeyaseelan Department Of Biostatistics CMC, Vellore Case Study Is goiter related to high altitudes? A group of researchers presented data showing rate of goiters between two areas that were different in altitudes. There was a higher rate of goiter among people who lived in counties located at high altitudes. Hence the researchers concluded that living at high altitudes was a factor associated with presence of goiter. PDQ Epidemiology Is goiter related to high altitudes? Distance to reach high altitudes Iodine evaporates before reaching high altitudes…. Definition What looks like a causal relationship between a supposed hazard and a disease may be due to another factor not taken into consideration. This additional factor is called a confounder, something that confuses the correct interpretation of data. GAMBLING CANCER SMOKING ALCOHOL OTHER FACTORS Unobserved association True causation Hypothetical Example Male Drug Placebo Cure No Cure 120 (60%) 80 60 (60%) 40 Total 200 100 ?2 = 0.00 Female Drug Placebo Cure No Cure 30 (30%) 70 60 (30%) 140 Total 100 200 ?2 = 0.00 Hypothetical Example (Cont.) Pooled Drug Placebo Cure No Cure 150 (50%) 150 100 (33.3%) 200 Total 300 300 ?2 = 17.14 (p 0.0001) BASIC CONCEPTS IN ASSESSMENT OF RISK Situations in which F is a confounder for a disease- exposure association. ( ) non- causal association; ( ) causal association. The letters E ?Exposure F ?Potential matching factor (confounder) D ?Disease Fig A. Indirect association between exposure and disease that is due to the factor F. Example: Association between drinking alcoholic beverages (E) and Lung cancer (D) would likely be explained in terms of an association between alcohol intake and cigarette smoking (F). F E D Fig A James. J. Schlesselman, 1982 Situation in which matching on a factor F is proper Fig B. E and F individually alter the risk of disease and are