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American Journal of Epidemiology Vol. 138, No. 11: 923-936
Copyright © 1993 by The Johns Hopkins University School of Hygiene and Public Health


review-article

Simulation Study of Confounder-Selection Strategies

George Maldonado1, and Sander Greenland2

1Division of Environmental and Occupational Health, School of Public Health, University of Minnesota Minneapolis, MN
2Department of Epidemiology, UCLA School of Public Health Los Angeles, CA

Correspondence to Dr. George Maldonado, Division of Environmental and Occupational Health, School of Public Health, University of Minnesota, 420 Delaware St. SE, Box 807, Minneapolis, MN 55455

In the absence of prior knowledge about population relations, investigators frequently employ a strategy that uses the data to help them decide whether to adjust for a variable. The authors compared the performance of several such strategies for fitting multiplicative Poisson regression models to cohort data: 1) the "change-in-estimate" strategy, in which a variable is controlled if the adjusted and unadjusted estimates differ by some important amount; 2) the "significance-test-of-the-covariate" strategy, in which a variable is controlled if its coefficient is significantly different from zero at some predetermined significance level; 3) the "significance-test-of-the-difference" strategy, which tests the difference between the adjusted and unadjusted exposure coefficients; 4) the "equiva-lence-test-of-the-difference" strategy, which significance-tests the equivalence of the adjusted and unadjusted exposure coefficients; and 5) a hybrid strategy that takes a weighted average of adjusted and unadjusted estimates. Data were generated from 8,100 population structures at each of several sample sizes. The performance of the different strategies was evaluated by computing bias, mean squared error, and coverage rates of confidence intervals. At least one variation of each strategy that was examined performed acceptably. The change-in-estimate and equivalence-test-of-the-difference strategies performed best when the cut-point for deciding whether crude and adjusted estimates differed by an important amount was set to a low value (10%). The significance test strategies performed best when the alpha level was set to much higher than conventional levels (0.20).

confounding factors (epidemiology); epidemiologic methods; models, statistical; logistic models; regression analysis; relative risk


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Occupational Exposures and Male Infertility
Am. J. Epidemiol., October 15, 2005; 162(8): 729 - 733.
[Abstract] [Full Text] [PDF]


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HeartHome page
O Wazni, D O Martin, N F Marrouche, M Shaaraoui, M K Chung, S Almahameed, R A Schweikert, W I Saliba, and A Natale
C reactive protein concentration and recurrence of atrial fibrillation after electrical cardioversion
Heart, October 1, 2005; 91(10): 1303 - 1305.
[Abstract] [Full Text] [PDF]


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Eval Health ProfHome page
E. D. Cox, M. A. Smith, and J. M. Bartell
Managing Febrile Infants: Impact of Literature Recommendations Published During a Physician's Residency
Eval Health Prof, September 1, 2005; 28(3): 328 - 348.
[Abstract] [PDF]


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Violence Against WomenHome page
M. A. Kernic, D. J. Monary-Ernsdorff, J. K. Koepsell, and V. L. Holt
Children in the Crossfire: Child Custody Determinations Among Couples With a History of Intimate Partner Violence
Violence Against Women, August 1, 2005; 11(8): 991 - 1021.
[Abstract] [PDF]


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Occup. Environ. Med.Home page
R McNamee
Regression modelling and other methods to control confounding
Occup. Environ. Med., July 1, 2005; 62(7): 500 - 506.
[Full Text] [PDF]


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ChestHome page
M. E. Kreider, J. D. Christie, B. Thompson, L. Newman, C. Rose, J. Barnard, E. Bresnitz, M. A. Judson, D. T. Lackland, M. D. Rossman, et al.
Relationship of Environmental Exposures to the Clinical Phenotype of Sarcoidosis
Chest, July 1, 2005; 128(1): 207 - 215.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
T. Sturmer, S. Schneeweiss, M. A. Brookhart, K. J. Rothman, J. Avorn, and R. J. Glynn
Analytic Strategies to Adjust Confounding using Exposure Propensity Scores and Disease Risk Scores: Nonsteroidal Antiinflammatory Drugs and Short-term Mortality in the Elderly
Am. J. Epidemiol., May 1, 2005; 161(9): 891 - 898.
[Abstract] [Full Text] [PDF]


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Int J EpidemiolHome page
C. Shapiro-Mendoza, B. J Selwyn, D. P Smith, and M. Sanderson
Parental pregnancy intention and early childhood stunting: findings from Bolivia
Int. J. Epidemiol., April 1, 2005; 34(2): 387 - 396.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
V. L. Holt, K. L. Cushing-Haugen, and J. R. Daling
Risk of Functional Ovarian Cyst: Effects of Smoking and Marijuana Use according to Body Mass Index
Am. J. Epidemiol., March 15, 2005; 161(6): 520 - 525.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
L. G. Spector, Y. Xie, L. L. Robison, N. A. Heerema, J. M. Hilden, B. Lange, C. A. Felix, S. M. Davies, J. Slavin, J. D. Potter, et al.
Maternal Diet and Infant Leukemia: The DNA Topoisomerase II Inhibitor Hypothesis: A Report from the Children's Oncology Group
Cancer Epidemiol. Biomarkers Prev., March 1, 2005; 14(3): 651 - 655.
[Abstract] [Full Text] [PDF]


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JNCI J Natl Cancer InstHome page
E. T. Chang, H. Hjalgrim, K. E. Smedby, M. Akerman, E. Tani, H. E. Johnsen, B. Glimelius, H.-O. Adami, and M. Melbye
Body Mass Index and Risk of Malignant Lymphoma in Scandinavian Men and Women
J Natl Cancer Inst, February 2, 2005; 97(3): 210 - 218.
[Abstract] [Full Text] [PDF]


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Cancer Epidemiol. Biomarkers Prev.Home page
E. T. Chang, K. Ekstrom Smedby, S. M. Zhang, H. Hjalgrim, M. Melbye, A. Ost, B. Glimelius, A. Wolk, and H.-O. Adami
Dietary Factors and Risk of Non-Hodgkin Lymphoma in Men and Women
Cancer Epidemiol. Biomarkers Prev., February 1, 2005; 14(2): 512 - 520.
[Abstract] [Full Text] [PDF]


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DiabetesHome page
D. B. Carr, K. M. Utzschneider, E. J. Boyko, P. J. Asberry, R. L. Hull, K. Kodama, H. S. Callahan, C. C. Matthys, D. L. Leonetti, R. S. Schwartz, et al.
A Reduced-Fat Diet and Aerobic Exercise in Japanese Americans With Impaired Glucose Tolerance Decreases Intra-Abdominal Fat and Improves Insulin Sensitivity but not {beta}-Cell Function
Diabetes, February 1, 2005; 54(2): 340 - 347.
[Abstract] [Full Text] [PDF]


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AJPHHome page
N. Dole, D. A. Savitz, A. M. Siega-Riz, I. Hertz-Picciotto, M. J. McMahon, and P. Buekens
Psychosocial Factors and Preterm Birth Among African American and White Women in Central North Carolina
Am J Public Health, August 1, 2004; 94(8): 1358 - 1365.
[Abstract] [Full Text] [PDF]


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Am J EpidemiolHome page
F. Dominici, D. Spiegelman, and S. R. Cole
Methodological Contributions to the American Journal of Epidemiology
Am. J. Epidemiol., August 1, 2004; 160(3): 197 - 198.
[Full Text] [PDF]


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Scand J Public HealthHome page
L. Kaerlev, L. B. Jacobsen, J. Olsen, and J. P. Bonde
Long-term sick leave and its risk factors during pregnancy among Danish hospital employees
Scand J Public Health, March 1, 2004; 32(2): 111 - 117.
[Abstract] [PDF]


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AJPHHome page
M. Siegel, A. B. Albers, D. M. Cheng, L. Biener, and N. A. Rigotti
Effect of Local Restaurant Smoking Regulations on Environmental Tobacco Smoke Exposure Among Youths
Am J Public Health, February 1, 2004; 94(2): 321 - 325.
[Abstract] [Full Text] [PDF]


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PediatricsHome page
F. DeStefano, T. K. Bhasin, W. W. Thompson, M. Yeargin-Allsopp, and C. Boyle
Age at First Measles-Mumps-Rubella Vaccination in Children With Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta
Pediatrics, February 1, 2004; 113(2): 259 - 266.
[Abstract] [Full Text] [PDF]



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