PSM - Confounders

00:01:02- Confounders- Definitions

Confounder

Independent Outcome Dependent Outcome

● They are variables common to both exposure and outcome
● They are independent risk factors of the outcome
● In a study design, you can have both known and unknown confounders. Confounders are
distributed unequally between two groups.

00:07:26- Disadvantage Of Confounders,

● Role of Alcohol in etiology of esophageal cancer. Smoking is a confounder because:

Smoking

Alcohol Oesophageal cancer

● Role of Coffee drinking in etiology of Heart Disease Smoking is a confounder because:

Smoking

Coffee Heart Disease

00:07:42- Techniques To Eliminate Confounders

A) Matching: Eliminates known confounders
B) Randomization: Eliminates known and unknown confounders
C) Restriction
D) Stratification
E) Multivariate Regression models: Used to eliminate multiple confounders
 Best to eliminate confounders: Stratified randomization

00:11:29- Effect Modifier

  Aggravates or decreased the effect of exposure on the outcome, but is not related to either of
them.
 The magnitude of effect of an exposure on outcome will vary according to the presence of the
third factor
 There must be a true relation between variable and outcome

Malnutrition

Bilirubin Brain Damage

00:15:41- Spurious Association

 False associations between exposure and outcome.

Eg. Neonatal mortality is higher in newborns than those newborns born in hospitals. False as
only cases of worse prognosis come to hospitals.

00:17:06- Clinical Vignettes Effect Modifiers

1. Systematic error in determination of association between exposure and disease, is

termed as?
(A) Chance
(B) Probability
(C) Bias
(D) Confounding
Ans: C bias
2. Recall information bias is unlikely to affect cohort studies because?
(A) Data collection is prospective
(B) Large no of subjects is usually included
(C) Exposure is usually determined prior to disease occurrence
(D) Actual relative risk can be determined
Ans. C. Exposure is usually determined prior to occurrence of disease
3. Recall bias mostly seen in?
(A) Case Control
(B) Cohort
(C) RCT
(D) Field Trial
Ans. A Case control
4. Double blind means?
(A) Observer is blind about the study
(B) Person or groups being observed are blind
 (C) Both observer and observed group is blind
(D) Interpreters and analyzers are blind about study
Ans. C. Both observer and observed are blind.
5. Matching reduces which bias in case control study?
(A) Selection bias
(B) Response bias
(C) Confounding factor
(D) Berksonian bias
Ans. C Confounding factor
6. Matching is done for removal of?
(A) Bias
(B) Known confounding
(C) Unknown confounding
(D) Known + unknown confounding
Ans. B Known confounders
7. A researcher wants to compare blood lipid profile of smokers and non-smokers,
but is concerned that smokers might differ from nonsmokers in their diet,
exercise etc. This is an example of?
(A) Recall bias
(B) Information bias
(C) Hawthorne bias
(D) Selection Bias
Ans. E selection bias
8. Hawthorne bias is seen in a?
(A) Cohort study
(B) Case control studt
(C) Cross Sectional study
(D) All of the above
Ans. Cohort study
9. Interviewer bias is associated with which type of study design?
(A) Cohort
(B) Case control
(C) Cross sectional
(D) Ecological
Ans. Case control
10. Berksonian bias is a type of?
(A) Selection bias
(B) Confounder
(C) Subject Bias
(D) All of the above
Ans. Selection bias
11. Hospital patient admission rates differ in different hospitals for different diseases.
This causes which bias?
(A) Subject
 (B) Investigator
(C) Berksonian
(D) Analyzer Bias
Ans. Berksonian bias
12. Selection bias can be eliminated by?
(A) Randomisation
(B) Single blinding
(C) Double blinding
(D) Matching
Ans. Randomisation
13. Which is true regarding confounding factors except?
(A) Associated with exposure under consideration
(B) Distributed equally in study and controls
(C) Associated to exposure and disease
(D) Related to matching in case control
Ans. B Distributed equally in study and controls
14. What is confounding factor?
(A) Factor associated with both exposure and disease and is distributed
unequally in study and control groups
(B) Factor associated with exposure only and is distributed unequally in study
and control groups
(C) Factor associated with disease only and is distributed unequally in study and
control groups
(D) Factor associated with both exposure disease only and is distributed equally
in study and control groups
(E) Ans. A Factor associated with both exposure and disease and is distributed
unequally in study and control groups
15. A study is established to find association between smoking and lung cancer and
found that exercise people had more lung cancer. Hence exercise is?
(A) Selection bias
(B) Effect modifier
(C) Confounding
(D) Any of the above
Ans. B. effect modifier
16. A study in India of 5000 births at home and 111 births in hospitals showed
perinatal mortality of 4.4/1000 in home and 26/1000 in hospital births. This
association between perinatal births and hospital us called as?
(a) Spurious association
(b) Inappropriate association
(c) Indirect association
(d) Confounder association
Ans. (A) spurious