Table XX – Internal and External Validity

Internal Validity: the ability of a study to measure what it set out to measure1
Selection Bias: are
treatment and control Berkson Paradox1 Results from simply observing some events more than others. For example:
groups comparable hospital-based studies that was looking at the association of certain risk factors
and disease progression can have a disproportionate number of people who
have been exposed to a ‘risk factor’ and developed the ‘disease’. This occurs
because the people who have been exposed to the risk factor but did not
develop the disease are not as likely to be captured in a hospital-based sample.
1
Neyman bias Occurs when there is a gap in time between the event of interest and the
selection into the study. For example, if you were studying the relationship
between strenuous activity and heart attacks and you were interviewing people
about the cause of a past heart attack, the sample would be missing all the
people who had a heart attack and died.
1
Non-response bias Survey non-respondents can be different from respondents in important ways.
This in one of the reasons the Canadian Census is mandatory.
1
Unmasking Bias An intervention could cause an underlying and unrelated condition to become
observable. The unmasking bias makes it appear as if the underlying condition
was caused by the intervention when it was not.
1
Information Bias: to Ascertainment Bias Occurs when information is gathered in different ways. For example,
minimize the potential information shared by a participant in a hospital waiting room may be different
bias the information that information shared in a private telephone conversation.
should be gathered by Diagnostic Suspicion Occurs when there is a more intensive search of disease in the group exposed
1
people blind to the Bias to the intervention because there is suspicion that the disease must be present.
1
case-control Family History Bias Individual with a family history of an exposure or disease may receive different
designation of the information than those not exposed.
participant Recall Bias 1
Individuals may recall of past events may differ among groups particularly if
they are trying to rationalize a current event.
Mismeasurement Occurs when there has been changes in definitions or survey methods for
Bias2 surveys that are repeated over a number of periods such as the Canadian

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 Community Health Survey.
Attrition Bias Occurs when there is a differential loss of participants with in the treatment
and comparison group.
Cofounding Bias occurs Omitted Variable Occurs when a causal factor is not included in the analysis. For example: if a
when the effect being Bias2 study is looking at the impact of oral contraceptives on heart attack, and
measured is cause by women who use oral contraceptives also smoked more than women who do
an unknown third not use oral contraceptives, the observed effect could have been caused by the
factor. smoking and not the contraceptive.

Cofounding can be controlled in a number of ways depending on the study:

restrict the sample to those not exposed to the cofounding variable, pairwise
match the sample by cofounding factor, stratification of the sample by
cofounding factor, and the use of multivariate modelling techniques. 1
2
Simultaneity Occurs when the outcome is jointly determined by two different explanatory
variables.
2
Other Trends in Outcomes Changes that occur simply because time has past such as inflation, aging.
2
Political Economy Occurs when elevating outcomes related to a policy change and the
government is responding to the outcome. *not sure this is correct
Misspecification of Regression modeling does not control for group correlation in the error term.
2
variances For example, people in certain groups may be similar in ways that are not
observable.
Omitted Interaction2 Occurs when there are trend difference between the treatment and
comparison group.
External Validity: the results of the study are generalizable1
Interaction of The treatment group may not be representative of the population or the
selection and treatment may differ is some ways from the one under consideration.
treatment
Interaction of setting The treatment effect may differ across geographic or institutional settings.
and treatment
Interaction of history The effect of the treatment may differ over time. For example, a temporary
and treatment intervention may elicit a greater response than a permanent intervention. A

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 new intervention may elicit an initial change that returns to baseline over time.

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