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      Is a Cutoff of 10% Appropriate for the Change-in-Estimate Criterion of Confounder Identification?

      research-article
      1 , 2
      Journal of Epidemiology
      Japan Epidemiological Association
      causality, confounding factors, regression, simulation, statistical models

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          Abstract

          Background

          When using the change-in-estimate criterion, a cutoff of 10% is commonly used to identify confounders. However, the appropriateness of this cutoff has never been evaluated. This study investigated cutoffs required under different conditions.

          Methods

          Four simulations were performed to select cutoffs that achieved a significance level of 5% and a power of 80%, using linear regression and logistic regression. A total of 10 000 simulations were run to obtain the percentage differences of the 4 fitted regression coefficients (with and without adjustment).

          Results

          In linear regression, larger effect size, larger sample size, and lower standard deviation of the error term led to a lower cutoff point at a 5% significance level. In contrast, larger effect size and a lower exposure–confounder correlation led to a lower cutoff point at 80% power. In logistic regression, a lower odds ratio and larger sample size led to a lower cutoff point at a 5% significance level, while a lower odds ratio, larger sample size, and lower exposure–confounder correlation yielded a lower cutoff point at 80% power.

          Conclusions

          Cutoff points for the change-in-estimate criterion varied according to the effect size of the exposure–outcome relationship, sample size, standard deviation of the regression error, and exposure–confounder correlation.

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          Most cited references7

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          The impact of confounder selection criteria on effect estimation.

          Much controversy exists regarding proper methods for the selection of variables in confounder control. Many authors condemn any use of significance testing, some encourage such testing, and other propose a mixed approach. This paper presents the results of a Monte Carlo simulation of several confounder selection criteria, including change-in-estimate and collapsibility test criteria. The methods are compared with respect to their impact on inferences regarding the study factor's effect, as measured by test size and power, bias, mean-squared error, and confidence interval coverage rates. In situations in which the best decision (of whether or not to adjust) is not always obvious, the change-in-estimate criterion tends to be superior, though significance testing methods can perform acceptably if their significance levels are set much higher than conventional levels (to values of 0.20 or more).
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            Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study.

            We have previously reported that regular physical activity reduces risk of chronic obstructive pulmonary disease (COPD) exacerbation. We hypothesized that higher levels of regular physical activity could reduce the risk of COPD by modifying smoking-related lung function decline. To estimate the longitudinal association between regular physical activity and FEV(1) and FVC decline and COPD risk. A population-based sample (n = 6,790) was recruited and assessed with respect to physical activity, smoking, lung function, and other covariates, in Copenhagen in 1981-1983, and followed until 1991-1994. Mean level of physical activity between baseline and follow-up was classified into "low," "moderate," and "high." FEV(1) and FVC decline rates were expressed as milliliters per year. COPD was defined as FEV(1)/FVC < or = 70%. Adjusted associations between physical activity and FEV(1) and FVC decline, and COPD incidence, were obtained using linear and logistic regression, respectively. Active smokers with moderate and high physical activity had a reduced FEV(1) and FVC decline compared with those with low physical activity (relative change of +2.6 and +4.8 ml/yr of FEV(1), P-for-trend = 0.006, and +2.6 and +7.7 ml/yr of FVC, P-for-trend < 0.0001, for the moderate and high physical activity group, respectively), after adjusting for all potential confounders and risk factors of lung function decline. Active smokers with moderate to high physical activity had a reduced risk of developing COPD as compared with the low physical activity group (odds ratio, 0.77; p = 0.027). This prospective study shows that moderate to high levels of regular physical activity are associated with reduced lung function decline and COPD risk among smokers.
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              Regression modelling and other methods to control confounding.

              R McNamee (2005)
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                Author and article information

                Journal
                J Epidemiol
                J Epidemiol
                JE
                Journal of Epidemiology
                Japan Epidemiological Association
                0917-5040
                1349-9092
                5 March 2014
                7 December 2013
                2014
                : 24
                : 2
                : 161-167
                Affiliations
                [1 ]School of Public Health, University of Hong Kong, Hong Kong
                [2 ]School of Nursing, Hong Kong Polytechnic University, Hong Kong
                Author notes
                Address for correspondence. Dr Paul H. Lee, School of Nursing, PQ433, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (e-mail: paul.h.lee@ 123456polyu.edu.hk ).
                Article
                JE20130062
                10.2188/jea.JE20130062
                3983286
                24317343
                f5037562-9ec5-49a6-81c1-dac37fb10dfa
                © 2013 Paul H. Lee.

                This is an open access article distributed under the terms of Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 May 2013
                : 17 September 2013
                Categories
                Short Communication
                Theory and Statistics

                causality,confounding factors,regression,simulation,statistical models

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