Confounding and effect modification in studies of diet and childhood asthma and allergies
Confounding and effect modification in studies of diet and childhood asthma and allergies
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DOI：
10.1111/j.1398-9995.2012.02858.x
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发表时间：
2012-08-01
期刊：
影响因子：
12.4
通讯作者：
Sheikh, A.
中科院分区：
文献类型：
--
作者：
Nurmatov, U.;Nwaru, B. I.;Sheikh, A.
目的提出一套流行病学调查中应考虑的混杂因素和效应调节因子。方法两名评论者独立批评了最近的系统性综述中包含的研究，并提取了有关所考虑的混杂因素和效应修饰因素以及用于证明纳入合理性的方法的数据。结果62篇文献中，队列研究20篇，病例对照研究16篇，横断面研究25篇，生态学研究1篇。所有队列、横断面和生态学研究都对混杂因素或效应修正进行了一些调整，但仅7/16（44%）例病例对照研究如此。在53项考虑混杂因素或效应改变的研究中，39/53（74%）没有给出纳入所考虑变量的理由。证明纳入变量合理性的研究是基于经验证据（n=10）、概念论证（n=7）或两者结合（n=3）。混杂因素主要通过回归模型来处理，但也有一些病例对照研究使用匹配和方差分析。十项研究处理效果修改分层，八个测试的相互作用，五个使用这两种策略。结论：我们发现在饮食和儿童哮喘/过敏发生的研究中，在处理混杂因素和影响修正方面存在很大的缺陷。变量的选择应基于概念考虑和经验证据。使用这种方法，我们提出了一套全面的混杂因素和效应调节剂，需要考虑在未来的研究。
Objective To propose a comprehensive set of confounders and effect modifiers that should be considered in epidemiologic investigations. Methods Two reviewers independently critiqued studies included in a recent systematic review and extracted data on the confounders and effect modifiers that were considered and the approaches used to justify inclusion. Results Of the 62 studies reviewed, 20 were cohort, 16 casecontrol, 25 cross-sectional studies, and one ecologic study. All cohort, cross-sectional, and ecologic studies had some adjustment for confounding or consideration of effect modification, but this was only the case for 7/16 (44%) casecontrol studies. Of the 53 studies that considered confounding or effect modification, 39/53 (74%) gave no justification for the inclusion of the variables considered. Studies that justified the inclusion of the variables did so based on empirical evidence (n=10), conceptual justification (n=7), or a combination of the two (n=3). Confounding was handled mainly by using regression modeling, but some casecontrol studies utilized matching and anova. Ten studies handled effect modification by stratification, eight tested for interaction, and five used both strategies. Conclusions We have found substantial shortcomings in the handling of confounding and effect modification in studies of diet and development of childhood asthma/allergies. Selection of variables should be based on conceptual considerations and empirical evidence. Using this approach, we have proposed a comprehensive set of confounders and effect modifiers that need to be considered in future studies.