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American Journal of Epidemiology Vol. 137, No. 11: 1259-1272
Copyright © 1993 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Cautions in the Use of Antecedents as Surrogates for Confounders

Beth W. Alderman1, Anna E. Barén2 and David A. Savitz3

1Department of Epidemiology, SC-36 University of Washington Seattle, WA 98195
2Department of Preventive Medicine and Biometrics, University of Colorado Denver, CO
3Department of Epidemiology, University of North Carolina Chapel 1-1111, NC

When lacking information on confounding variables, epidemiologists have used surrogates which are antecedents of both the exposures and confounders of interest. The usefulness of this strategy is explored in a series of scenarios for a prospective epidemiologic study wherein risk ratios relating antecedent to confounder, antecedent to exposure, and confounder to exposure were varied. Antecedent-adjusted, con founder-adjusted, and crude risk ratios were calculated and compared. The antecedent- adjusted risk ratio was useful, that is, was closer to the confounder-adjusted risk ratio than was the crude risk ratio, in 1,067 (49%) of 2,187 scenarios. The antecedent-adjusted risk ratio, the crude risk ratio, and the risk ratio relating confounder to exposure together predicted the usefulness of the antecedent (or any variable) as a confounder proxy. The antecedent was useful In 97% of scenarios wherein: 1) the antecedent- adjusted risk ratio was less than the crude risk ratio, and the risk ratio relating confounder to exposure was greater than 1 .0, or 2) the antecedent-adjusted risk ratio was greater than the crude risk ratio, and the risk ratio relating confounder to exposure was less than 1.0. In the remaining scenarios, it was useful only 5% of the time.

confounding factors (epidemiology); decision making; epidemiologic methods


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