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Confounding,
Principles of
Causality
HSC 3102
Ms. Sasha
Walrond
August,
2015
Outline
Define chance
2 Define Sampling Error
3 Define Bias and types of bias
4 Use the principles of causality to interpret estimates
of association
1
Chance
Chance is a random error appearing to cause an
association between an exposure and an outcome.
2 A principal assumption in epidemiology is that we can
draw inference about the experience of the entire
population based on the evaluation of a sample of the
population.
3 However a problem with drawing such an inference is
that the play of chance may affect the results of an
epidemiological study because the effects of random
variation from sample to sample.
1
Sampling Error
Because of chance, different samples will produce
different results and therefore must be taken into
account when using a sample to make inferences
about a population.
2 This difference is referred to as the sampling error and
the variability is measures by the standard error.
3 Sampling error may result in:
1
1
2
4
Bias
Bias is any systematic error in the design, conduct or
analysis of a study that results in a mistaken estimate
of an exposures effect on the risk of disease.
2 Types of biases in epidemiologic studies:
1
1
2
Selection Bias
Information Bias
Selection Bias
Selection bias is an error in selecting a study group or groups
within the study and can have a major impact on the internal
validity of the study and the legitimacy of the conclusion.
2 If the way in which case and controls, or exposed and nonexposed individuals were selected is such that an apparent
association is observed-even if , in reality, exposure and
disease are not associated- the apparent association is the
result of selection bias.
3 Response bias is a type of selection bias. Example, if we are
studying the possible relationship of an exposure and a disease
and the response rate of potential subjects is higher in people
with the disease who were exposed than in people who were
not exposed, an apparent association could be observed even if
in reality there is no association.
Another example, 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.
1
Information Bias
1
3
4
5
6
Association to Causation
1
populations.
Types of association
1
Confounding
A confounder accounts, totally or in part, for the
observed association between exposure and outcome.
2 The
confounder is associated with both the
exposure and the outcome.
1
Confoundi
ng
Confoundi
ng
1.
Smoking is
a
known
risk factor
for
pancreatic
cancer
Smoking is
associated
with
coffee
drinking, but
is
not
a
result
of
2.
coff ee drinking.
Causal pathways
1
Direct or indirect
What is a cause?
1
2
3
4
3
4
Causality in epidemiology:
important note
In epidemiology, causation is determined by what
occurs in groups of people or populations as opposed
to what occurs in any particular individual
2 From the group data, we can make predictions about
individuals, but we cannot expect that the predictions
will always be correct.
3 For example, everyone seems to know someone who
smoked four packs of cigarettes a day, had high
blood pressure and drank like a fish, but lived until
103.
1
2.
3.
4.
5.
References
th