Bias – systematic error

à NOT affected by study size

• Confounding
• Selection bias

Bias and
• Information bias

chance Chance – random error

à Decreases with increasing study size
 • Bias towards the null (observed
effect larger than true effect)

• Bias away from the null (observed

effect larger than true effect)
Bias and
DIRECTION
 • Confounding: Third factor that
changes the association between
exposure and outcome
• Selection bias: Resulting form
Types of Bias selection or retention of the
participants/study population
• Information bias: poor
measurement, of exposure,
outcome or confounders
Confounder
 • Medication and risk of heart
failure
• Medication prescribed for
hypertension
Example • Reduce hypertension ~ reduce
heart failure
confounding
 Case-control study

Does smoking increase risk of stroke?

Selection
Cases: patients admitted for stroke
bias:
example Controls: patients admitted for
everything else
Problem?
Cases and controls from same source
population in relation to exposure
Exposure associated with hospitalisation (less
healthy)
RESULT?
Case-control
àUnderestimation of effect smoking on risk of
stroke

= Selection bias
Healthy workers bias

Attrition (loss of participants) Other

Volunteer bias
selection
biases
 Misclassification to exposure or
disease status

Researcher knows assignment of

Information treatment group
bias: example
à High expectations ~ more likely
to identifying better outcome
Other Recall bias
information
biases Hawthorne effect (observer bias)