BIAS AND CONFOUNDERS

DEFINITION
• BIAS- IS AN ERROR THAT RESULTS IN THE
SYSTEMATIC DEVIATION OF THE TRUE
ESTIMATION OF THE ASSOCIATION BETWEEN
THE EXPOSURE AND OUTCOME
• TYPES:
• INFORMATION (MEASUREMENT BIAS)
• SELECTION BIAS
 INFORMATION (MEASUREMENT
BIAS)
• OCCURS AT DATA COLLECTION STAGE. THIS
TYPE OF BIAS IS COMMON IN A CASE-
CONTROL STUDY (RECALL BIAS). DURING AN
INTERVIEW, THIS TYPE OF BIAS IS MOST
LIKELY TO OCCUR DURING AN INTERVIEWER –
ADMINSTERED METHOD OF DATA
COLLECTION.
• FAULTY DATA COLLECTION TOOLS; SCALE, BP,
GLUCOMETERS ETC
 SELECTION BIAS
• OCCURS WHEN THE STUDY PARTICIPANTS
SELECTED FOR A STUDY DO NOT REPRESENT
THE GENERAL POPULATION TO WHICH THE
STUDY WILL ULTIMATELY BE APPLIED TO. IT
CAN ALSO OCCUR IF STUDY GROUPS ARE NOT
COMPARABLE
• EXAMPLE A STUDY AMONG TERTIARY
FACILITY HEALTH WORKERS BUT DATA
COLLECTED FROM PHC FACILITIES
 AVOIDING BIAS
• BLINDING (INFORMATION BIAS)
• USE OF OBJECTIVE RECORDS (INFORMATION
BIAS)
• USE OF WELL DESIGNED QUESTIONNAIRE
• USE QUALITY MEASUREMENT TOOLS; PRE-
TESTING IS IMPORTANT
 CONFOUNDERS
• CONFOUNDERS ARE VARIABLES THAT
PROVIDE AN ALTERNATIVE ASSOCIATION
BETWEEN AN EXPOSURE AND AN OUTCOME

• OCCUPATION LUNG CANCER

• SMOKING
• CONFOUNDING OCCURS WHEN AN OBSERVED
ASSOCIATION BETWEEN AN EXPOSURE AND
AN OUTCOME IS DISTORTED BECAUSE THE
EXPOSURE OF INTEREST IS CORRELATED WITH
ANOTHER RISK FACTOR
 CONTROL OF CONFOUNDERS
• DONE AT THE DESIGN STAGE AND/OR THE
ANALYSIS STAGE
 DESIGN STAGE
• RESTRICTION: One way to control
confounding is to limit the study to people
who have particular characteristics.
• For example, in a study on the effects of
coffee on coronary heart disease,
participation in the study could be restricted
to nonsmokers, thus removing any potential
effect of confounding by cigarette smoking.
 RANDOMISATION
• THIS IS THE BEST METHOD USED TO CONTROL
FOR CONFOUNDERS
• IT ENSURES THE CONFOUNDING VARIABLES
ARE EQUALLY DISTRIBUTED AMONG THE TWO
GROUPS BEING COMPARED. USED MORE IN
INTERVENTIONAL STUDIES
• A STUDY TO DETERMINE THE EFFECT ON A
SMOKING CESSATION INTERVENTION AMONG
YOUTHS
 MATCHING
• COMMONLY USED IN CASE-CONTROL STUDIES
AND ENSURES THE CONTROLS SELECTED ARE
SIMILAR TO CASES IN TERMS OF POTENTIAL
CONFOUNDERS
 ANALYSIS STAGE
• STRATIFICATION
• STATISTICAL MODELLING