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Understanding Confounding in Disease Studies

The document discusses confounding in research, specifically how a third factor (like smoking) can influence the perceived relationship between an exposure (coffee drinking) and an outcome (pancreatic cancer). It also explores the interaction of multiple risk factors in disease causation, defining positive and negative interactions, and the differences between additive and multiplicative models of risk. The document emphasizes the importance of understanding these interactions to accurately assess disease incidence rates and attributable risks.

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13 views30 pages

Understanding Confounding in Disease Studies

The document discusses confounding in research, specifically how a third factor (like smoking) can influence the perceived relationship between an exposure (coffee drinking) and an outcome (pancreatic cancer). It also explores the interaction of multiple risk factors in disease causation, defining positive and negative interactions, and the differences between additive and multiplicative models of risk. The document emphasizes the importance of understanding these interactions to accurately assess disease incidence rates and attributable risks.

Uploaded by

shaziplus
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Interaction of Factors

MPH Karimov Doniyor


What do we mean by confounding? In a study of whether factor A is a cause of disease B, we
say that

a third factor, factor X, is a confounder if the following are true:

1. Factor X (smoking) is a known risk factor for disease B


(pancreatic cancer).
2. Factor X (smoking) is associated with factor A (coffee drinking),
but is not a result of factor A (coffee drinking).
Smoking was a confounder, because although we were interested in a
possible relationship between coffee drinking (factor A) and pancreatic
cancer (disease B), the following are true of smoking (factor X):

- Smoking is a known risk


factor for pancreatic cancer.
- Smoking is associated with
coffee drinking, but is not a
result of coffee drinking.
Confounding
A situation in which a non-causal
association between a given
exposure and an outcome is
observed as a result of the
influence of a third, unobserved,
factor, called a confounder. The
confounder is both associated
with the observed exposure and is
a cause of the outcome. From the
Latin cōnfundere, to mix
together, confuse

4
How do multiple factors interact in causing a
disease?
Birth Order and Down’s Syndrome

6
Maternal Age and Down’s Syndrome

7
Birth Order, Maternal Age and Down’s
Syndrome

8
Birth Order, Maternal Age and Down’s
Syndrome

9
Birth Order, Maternal Age and Down’s
Syndrome

83
What do we mean by interaction?
“When the incidence rate of disease in the presence of two or more
risk factors differs from the incidence rate expected to result from their
individual effects.”
Positive or negative interaction
• The effect can be greater than what we would expect (positive
interaction, synergism) or less than what we would expect (negative
interaction, antagonism).
Incidence Rates for Groups Exposed to Neither
Risk Factor or to One or two Risk Factors
Additive Model.
Incidence rates and Attributable risks for Groups
Exposed to neither risk factor or to one or two risk
factors.
Incidence Rates and
Attributable Risks. Additive Model
Incidence Rates for Groups Exposed to Neither
Risk Factor or to One or two Risk Factors
Incidence Rates and Relative
Risks for groups exposed to neither risk factor or to
one or two risk factors. Multiplicative Model
Incidence Rates and Relative
Risks. Multiplicative Model
What would we expect to see as a result of the independent
effects of two risk factors? Do we expect an additive
model or a multiplicative model?
• Most experts accept any effect greater than additive as evidence of
positive interaction, which is also called synergism.
Task 1

• Fill in the blank cell in the first table using the


additive model of interaction: ______

• Fill in the blank cell in the first table using the


multiplicative model of interaction: ______
Task 2
Is this additive or multiplicative?
No boundaries
With boundaries
Different interrelationships
in different settings
Dramatic synergy. Why?

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