Fewell Zoe, Davey Smith George, Sterne Jonathan A C
Department of Social Medicine, University of Bristol, Bristol, United Kingdom.
Am J Epidemiol. 2007 Sep 15;166(6):646-55. doi: 10.1093/aje/kwm165. Epub 2007 Jul 5.
Measurement error in explanatory variables and unmeasured confounders can cause considerable problems in epidemiologic studies. It is well recognized that under certain conditions, nondifferential measurement error in the exposure variable produces bias towards the null. Measurement error in confounders will lead to residual confounding, but this is not a straightforward issue, and it is not clear in which direction the bias will point. Unmeasured confounders further complicate matters. There has been discussion about the amount of bias in exposure effect estimates that can plausibly occur due to residual or unmeasured confounding. In this paper, the authors use simulation studies and logistic regression analyses to investigate the size of the apparent exposure-outcome association that can occur when in truth the exposure has no causal effect on the outcome. The authors consider two cases with a normally distributed exposure and either two or four normally distributed confounders. When the confounders are uncorrelated, bias in the exposure effect estimate increases as the amount of residual and unmeasured confounding increases. Patterns are more complex for correlated confounders. With plausible assumptions, effect sizes of the magnitude frequently reported in observational epidemiologic studies can be generated by residual and/or unmeasured confounding alone.
解释变量中的测量误差和未测量的混杂因素可能在流行病学研究中引发相当大的问题。人们已经充分认识到,在某些条件下,暴露变量中的无差异测量误差会产生向无效值偏倚。混杂因素中的测量误差会导致残余混杂,但这并非一个简单的问题,而且偏差的方向并不明确。未测量的混杂因素使情况更加复杂。关于由于残余或未测量的混杂因素可能合理出现的暴露效应估计中的偏倚量,一直存在讨论。在本文中,作者使用模拟研究和逻辑回归分析来调查当实际上暴露对结局没有因果效应时可能出现的明显暴露-结局关联的大小。作者考虑了两种情况,一种是暴露呈正态分布,有两个或四个呈正态分布的混杂因素。当混杂因素不相关时,暴露效应估计中的偏差会随着残余和未测量的混杂因素量的增加而增加。对于相关的混杂因素,模式更为复杂。在合理的假设下,仅残余和/或未测量的混杂因素就可以产生观察性流行病学研究中经常报告的那种效应大小。
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