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Telaah Artikel

BIAS
Ratno Widoyo, SKM, MKM

Error dalam Interpretasi


Could it be by chance?
Chose a non-representative population to study
(inadequate sample size)
Could it be due to bias?
Bias is a systematic error in the design, conduct or
analysis of a study that results in a mistaken
estimate of an exposures effect on the risk of
disease
(Schlesselman and Stolley, 1982)

ERROR

Systematic

Random

Random error: use of invalid outcome measure that


equally misclassifies cases and controls
Systematic Error : use of an invalid measures that
misclassifies cases in one direction and misclassifies
controls in another

Bias is systematic error

Bias
seharusny
a
digunakan
untuk kata
lain dari
systematic
error

Apa yang dimaksud BIAS?


Any trend in the collection, analysis, interpretation,
publication or review of data that can lead to
conclusions that are systematically different from
the truth
(Last, 2001)
A process at any state of inference tending to
produce results that depart systematically from
the true values
(Fletcher et al, 1988)
Systematic error in design or conduct of a study
(Szklo et al, 2000)

Tipe Bias

Selection bias
Unrepresentative nature of sample
Information (misclassification) bias
Errors in measurement of exposure of disease
Confounding bias
Distortion of exposure - disease relation by some
other factor

Tipe Bias

Selection bias
Unrepresentative nature of sample
Information (misclassification) bias
Errors in measurement of exposure of disease
Confounding bias
Distortion of exposure - disease relation by some
other factor

Selection bias

Selection bias is a method of participant selection


that distorts the exposure-outcome relationship from
that present in the target population

Selection bias
1.

Selection of a comparison group ("controls") that is not


representative of the population that produced the cases in a
case-control study. (Control selection bias)

2.

Differential loss to follow up in a cohort study, such that the


likelihood of being lost to follow up is related to outcome status
and exposure status. (Loss to follow-up bias)

3.

Refusal, non-response, or agreement to participate that is related


to the exposure and disease (Self-selection bias)

4.

Using the general population as a comparison group for an


occupational cohort study ("Healthy worker" effect)

5.

Differential referral or diagnosis of subjects

Information Bias

Information bias occurs when information is


collected differently between two groups, leading to
an error in the conclusion of the association

Information Bias

When information is incorrect, there is


misclassification

Differential misclassification occurs when


the level of misclassification differs between
the two groups

Non-differential misclassification occurs


when the level of misclassification does not
differ between the two groups

Information Bias
Interviewer knows the status of the subjects
before the interview process
Subjects may recall past exposure better or in
more detail if he or she has the disease (recall
bias)
Surrogates, such as relatives, provide exposure
information for dead cases, but living controls
provide exposure information themselves

Cara Mengontrol Information


Bias
Have a standardized protocol for data collection
Make sure sources and methods of data collection
are similar for all study groups
Make sure interviewers and study personnel are
unaware of exposure/disease status
Adapt a strategy to assess potential information
bias

Confounding

Confounding occurs when the observed result


between exposure and disease differs from the truth
because of the influence of the third variable

Confounding

Coffee

CHD

Smoking
Smoking is correlated with coffee drinking and
a risk factor even for those who do not drink
coffee

Confounding ?

Smoking

CHD

Coffee
Coffee drinking may be correlated with
smoking but is not a risk factor in nonsmokers

Approaches to the Problem of


Confounding
In designing and carrying out the study
Matching
In the data analysis
Adjustment