Indirect adjustment of relative risks of an exposure with multiple categories for an unmeasured confounder.

Abstract

RESULTS AND CONCLUSIONS

We provide examples involving studies of pediatric computer tomography scanning and leukemia and nuclear radiation workers and smoking to demonstrate that with externally sourced information, an investigator can assess whether confounding from unmeasured factors is likely to occur.

METHODS

For both multiplicative and additive RR models, we present formulae for indirect adjustment of observed RRs for unmeasured potential confounding variables when there are multiple categories. In addition, we suggest an alternative strategy to identify the characteristics that the confounder must have to explain fully the observed association.

PURPOSE

With observational epidemiologic studies, there is often concern that an unmeasured variable might confound an observed association. Investigators can assess the impact from such unmeasured variables on an observed relative risk (RR) by utilizing externally sourced information and applying an indirect adjustment procedure, for example, the "Axelson adjustment." Although simple and easy to use, this approach applies to exposure and confounder variables that are binary. Other approaches eschew specific values and provide only bounds on the potential bias.

More about this publication

Annals of epidemiology
  • Volume 28
  • Issue nr. 11
  • Pages 801-807
  • Publication date 01-11-2018

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