Control of confounding

Misclassification of a confounder leads to a loss of ability to control confounding,

although control may still be useful provided that misclassification of the confounder is
non-deferential. In general, control of confounding requires careful use of a prior
knowledge, as well as inference from the observed data.
Control in study design
Confounding can be controlled in the study design, or in the analysis, or both. Control at
the design stage involves three mains methods :
1. Randomization
The example for randomization methods is random allocation that to exposure
categories,but this is rarely an option in epidemiology which generally involves
observational studies,but the method is debatable whether randomized studies are
part of epidemiologi.
2. Restriction
Restricting the study to narrow ranges (white males aged 34-54) has conceptual
and computational advantages. But restriction can also decrease the potential
study subjects such as younger and older people because they will not be
observable.
3. Matching study on potentional confounders
A third method of control involves matching study subjects on potential
confounders. This will prevent age-sex-race confounding in a cohort study, but it
seldom dont because it may be very expensive. Matching may actually reduce
precision in a case control study if it is done on a factor which is associated with
exposure, but is not a risk factor for the disease of interest. However, matching on
a strong risk factor will usually increase the precision of effect estimate.
Control in the analysis
The analysis ideally should control simultaneously for all confounding factors. It is
usually not possible to control simultaneously for more than 2 or 3 confounders in a
stratified analysis. Control of confounding in the analysis involves stratifying the data
according to the levels of confounders and calculating and effect estimate which
summarizes the association across strata of confounders.