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American Journal of Epidemiology Vol. 129, No. 5: 1062-1071
Copyright © 1989 by The Johns Hopkins University School of Hygiene and Public Health

research-article

ESTIMATING AND CORRECTING FOR CONFOUNDER MISCLASSIFICATION

DAVID A. SAVITZ1, and ANNA E. BARÓN2

1Department of Epidemiology, School of Public Health, CB# 7400 Rosenau Hall, and Carolina Population Center, University of North Carolina Chapel Hill, NC 27599
2National Center for American Indian and Alaska Native Mental Health Research, Department of Psychiatry and Department of Preventive Medicine and Biometrics, University of Colorado Health Sciences Center Denver, CO.

Reprint requests to Dr. Savitz at this address

Confounder misclassification is as pervasive a problem in epidemiologic studies as misclassification of the primary exposure variables. Adjustment using imperfectly classified confounders has been shown to remove only part of the confounding effect of that variable, most important when studying an exposure postulated to have a modest effect in the presence of a strong confounder. The Per Cent Adjustment (amount of confounding bias removed using the misclassified measure relative to the total confounding bias present) is derived for several case-control scenarios, and is found to have a stable relation to the sensitivity and specificity of confounder classification. Figures are provided for estimation of the completely adjusted odds ratio given the results from the misclassified proxy and an estimate of the extent of misclassification. This offers a method for quantitative assessment of the impact of residual confounding that results from confounder misclassification, illustrated with studies of coffee consumption and bladder cancer in the presence of confounding by cigarette smoking.

epidemiologic methods


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