Confounding in Epidemiological Studies, Exams of Advanced Education

A comprehensive overview of the concept of confounding in epidemiological studies. It covers the definition of confounding, its sources, the effects it can have on the true association between an exposure and a disease, and the various methods used to identify and control for confounding factors. The document delves into the characteristics of a confounder, the criteria it must meet, and the different techniques employed to address confounding, such as randomization, matching, standardization, and stratified analysis. It also discusses the limitations and pros and cons of these methods. This detailed examination of confounding is highly relevant for students and researchers in the fields of epidemiology, public health, and biostatistics, as it equips them with the necessary knowledge to design and interpret epidemiological studies accurately.

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2024/2025

Available from 10/22/2024

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PHC 6001 Ch. 11 Confounding Exam
With 100% Correct Answers 2023
confounding - Correct answer-Which of the following can be thought of as a failure of
the comparison group to reflect the counterfactual experience of the exposed group?
*systematic difference* difference b/w groups being compared that distorts the true
association b/w an exposure and dz; an *inherent characteristic of the population
-occurs when the risk of dz in the unexposed group does not equal the risk of dz in the
exposed group had they been unexposed which means that the *difference in dz risk
b/w the exposed and unexposed is due to factors other than just the exposure*
Confounding Sources - Correct answer-1. experimental and cohort: occurs whenthe
exposed and unexposed groups differ by more than just the exposure, they differ by a
third variable
2. case control: occurs when cases and controls have *different characteristics*
confounding effects - Correct answer--results in distortion of the true association
between E and D. Can bias toward or away from null; can be adjusted for (or fixed) ...to
a point
-"mixing of effects" because the estimate of the effect of exposure on dz is distored b/c
it is mixed with the effect of other factors associated with the exposure and the disease.
Sometimes called the "third variable" problem.
DAG - Correct answer-Which of the following tools is a visual representation of the
relationship between a confounder, the exposure and the disease?
experimental studies - Correct answer-Which type of studies do not suffer from
confounding by severity mainly because randomization balances the severity
distribution of the compared groups?
literature review - Correct answer-Epidemiologists typically determine which variables
are potential confounders by conducting which of the following to ascertain all currently
known risk factors for the diseas under study?
randomization - Correct answer-Which of the following ensures that the treatment
assignment occurs in an unbiased fashion and will on average result in a balanced
distribution of both known and unknown confounders if the sample size is large
enough?
matching - Correct answer-Which of the following means that investigators select the
study subjects so that potential confounders are distributed in an identical manner?
Pros:
1. simple and effective control of characteristics being matched
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PHC 6001 Ch. 11 Confounding Exam

With 100% Correct Answers 2023

confounding - Correct answer-Which of the following can be thought of as a failure of the comparison group to reflect the counterfactual experience of the exposed group? systematic difference difference b/w groups being compared that distorts the true association b/w an exposure and dz; an *inherent characteristic of the population -occurs when the risk of dz in the unexposed group does not equal the risk of dz in the exposed group had they been unexposed which means that the difference in dz risk b/w the exposed and unexposed is due to factors other than just the exposure Confounding Sources - Correct answer-1. experimental and cohort: occurs whenthe exposed and unexposed groups differ by more than just the exposure, they differ by a third variable

  1. case control: occurs when cases and controls have different characteristics confounding effects - Correct answer--results in distortion of the true association between E and D. Can bias toward or away from null; can be adjusted for (or fixed) ...to a point -"mixing of effects" because the estimate of the effect of exposure on dz is distored b/c it is mixed with the effect of other factors associated with the exposure and the disease. Sometimes called the "third variable" problem. DAG - Correct answer-Which of the following tools is a visual representation of the relationship between a confounder, the exposure and the disease? experimental studies - Correct answer-Which type of studies do not suffer from confounding by severity mainly because randomization balances the severity distribution of the compared groups? literature review - Correct answer-Epidemiologists typically determine which variables are potential confounders by conducting which of the following to ascertain all currently known risk factors for the diseas under study? randomization - Correct answer-Which of the following ensures that the treatment assignment occurs in an unbiased fashion and will on average result in a balanced distribution of both known and unknown confounders if the sample size is large enough? matching - Correct answer-Which of the following means that investigators select the study subjects so that potential confounders are distributed in an identical manner? Pros:
  2. simple and effective control of characteristics being matched
  1. Useful for variables that are complex or difficult to capture (i.e. neighborhood) Cons:
  2. only possible for known, measured confounders
  3. can be difficult, expensive and time consuming ot find appropriate matches
  4. cannot evaluate matched variable standardization - Correct answer-Epidemiologists commonly use which of the following to control for demographic variables such as age, race, gender and calendar time? False - Correct answer-T/F The confounding variable must be more or less common in the comparison group than the exposed group. False - Correct answer-T/F Confounding is an all or none condition desribed merely by its presence or absense. True - Correct answer-T/F Confounding by severity in observational studies usually makes the therapy appear less effective than it appeared in experimental studies. counterfactual ideal - Correct answer-ideal comparison group would be the exact same people who are in the exposed group had they not been exposed; confounding is a failure to come close to this confounding criteria - Correct answer-must meet this:
  5. independent predictor of the outcome (is a risk factor for disease among people who are exposed)
  6. associated with the exposure (occurs more or less often among exposed than the unexposed)
  7. cannot be an intermediate on the causal pathway b/w exposure and dz (cannot be caused by the exposure) intermediate variable - Correct answer-lung capacity is an ___________ ______________ to running speed for males historical confounders - Correct answer-age, sex, race/ethnicity are examples of these restriction - Correct answer-limit people who are within one category of the confounder (i.e if sex is confounder, limit to only men or women) Pros: -simple : conceptually and pratically -effective control of characteristics Cons: -only possible for known, measured confounders -incomplete control for residual if not narrow enough -cannot evaluate restricted variable