An approach to quantifying the potential importance of residual confounding in systematic reviews of observational studies: A GRADE concept paper
Small relative effect sizes are common in observational studies of exposure in environmental and public health. However, such effects can still have considerable policy importance when the baseline rate of the health outcome is high, and many persons are exposed. Assessing the certainty of the evide...
Main Authors: | , , , , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Elsevier
2021-12-01
|
Series: | Environment International |
Subjects: | |
Online Access: | http://www.sciencedirect.com/science/article/pii/S0160412021004931 |
id |
doaj-ed9293b56c9a4989a09256316db64518 |
---|---|
record_format |
Article |
spelling |
doaj-ed9293b56c9a4989a09256316db645182021-10-01T04:48:31ZengElsevierEnvironment International0160-41202021-12-01157106868An approach to quantifying the potential importance of residual confounding in systematic reviews of observational studies: A GRADE concept paperJos H. Verbeek0Paul Whaley1Rebecca L. Morgan2Kyla W. Taylor3Andrew A. Rooney4Lukas Schwingshackl5Jan L. Hoving6S. Vittal Katikireddi7Beverley Shea8Reem A. Mustafa9M. Hassan Murad10Holger J. Schünemann11Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Corresponding author.Lancaster Environment Centre, Lancaster University, UKMcMaster University, Hamilton, CanadaNational Institute of Environment Health Science, USANational Institute of Environment Health Science, USAMedical Center - University of Freiburg; Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the NetherlandsUniversity of Glasgow, UKUniversity of Ottawa, CanadaUniversity of Kansas Medical Center, USMayo Clinic, Rochester, USMcMaster University, Hamilton, CanadaSmall relative effect sizes are common in observational studies of exposure in environmental and public health. However, such effects can still have considerable policy importance when the baseline rate of the health outcome is high, and many persons are exposed. Assessing the certainty of the evidence based on these effect sizes is challenging because they can be prone to residual confounding due to the non-randomized nature of the evidence. When applying GRADE, a precise relative risk >2.0 increases the certainty in an existing effect because residual confounding is unlikely to explain the association. GRADE also suggests rating up when opposing plausible residual confounding exists for other effect sizes. In this concept paper, we propose using the E-value, defined as the smallest effect size of a confounder that still can reduce an observed RR to the null value, and a reference confounder to assess the likelihood of residual confounding. We propose a 4-step approach. 1. Assess the association of interest for relevant exposure levels. 2. Calculate the E-value for this observed association. 3. Choose a reference confounder with sufficient strength and information and assess its effect on the observed association using the E-value. 4. Assess how likely it is that residual confounding will still bias the observed RR. We present three case studies and discuss the feasibility of the approach.http://www.sciencedirect.com/science/article/pii/S0160412021004931Body of evidenceSensitivity analysisE-valueCertainty of evidenceObservational studies |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jos H. Verbeek Paul Whaley Rebecca L. Morgan Kyla W. Taylor Andrew A. Rooney Lukas Schwingshackl Jan L. Hoving S. Vittal Katikireddi Beverley Shea Reem A. Mustafa M. Hassan Murad Holger J. Schünemann |
spellingShingle |
Jos H. Verbeek Paul Whaley Rebecca L. Morgan Kyla W. Taylor Andrew A. Rooney Lukas Schwingshackl Jan L. Hoving S. Vittal Katikireddi Beverley Shea Reem A. Mustafa M. Hassan Murad Holger J. Schünemann An approach to quantifying the potential importance of residual confounding in systematic reviews of observational studies: A GRADE concept paper Environment International Body of evidence Sensitivity analysis E-value Certainty of evidence Observational studies |
author_facet |
Jos H. Verbeek Paul Whaley Rebecca L. Morgan Kyla W. Taylor Andrew A. Rooney Lukas Schwingshackl Jan L. Hoving S. Vittal Katikireddi Beverley Shea Reem A. Mustafa M. Hassan Murad Holger J. Schünemann |
author_sort |
Jos H. Verbeek |
title |
An approach to quantifying the potential importance of residual confounding in systematic reviews of observational studies: A GRADE concept paper |
title_short |
An approach to quantifying the potential importance of residual confounding in systematic reviews of observational studies: A GRADE concept paper |
title_full |
An approach to quantifying the potential importance of residual confounding in systematic reviews of observational studies: A GRADE concept paper |
title_fullStr |
An approach to quantifying the potential importance of residual confounding in systematic reviews of observational studies: A GRADE concept paper |
title_full_unstemmed |
An approach to quantifying the potential importance of residual confounding in systematic reviews of observational studies: A GRADE concept paper |
title_sort |
approach to quantifying the potential importance of residual confounding in systematic reviews of observational studies: a grade concept paper |
publisher |
Elsevier |
series |
Environment International |
issn |
0160-4120 |
publishDate |
2021-12-01 |
description |
Small relative effect sizes are common in observational studies of exposure in environmental and public health. However, such effects can still have considerable policy importance when the baseline rate of the health outcome is high, and many persons are exposed. Assessing the certainty of the evidence based on these effect sizes is challenging because they can be prone to residual confounding due to the non-randomized nature of the evidence. When applying GRADE, a precise relative risk >2.0 increases the certainty in an existing effect because residual confounding is unlikely to explain the association. GRADE also suggests rating up when opposing plausible residual confounding exists for other effect sizes. In this concept paper, we propose using the E-value, defined as the smallest effect size of a confounder that still can reduce an observed RR to the null value, and a reference confounder to assess the likelihood of residual confounding. We propose a 4-step approach. 1. Assess the association of interest for relevant exposure levels. 2. Calculate the E-value for this observed association. 3. Choose a reference confounder with sufficient strength and information and assess its effect on the observed association using the E-value. 4. Assess how likely it is that residual confounding will still bias the observed RR. We present three case studies and discuss the feasibility of the approach. |
topic |
Body of evidence Sensitivity analysis E-value Certainty of evidence Observational studies |
url |
http://www.sciencedirect.com/science/article/pii/S0160412021004931 |
work_keys_str_mv |
AT joshverbeek anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT paulwhaley anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT rebeccalmorgan anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT kylawtaylor anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT andrewarooney anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT lukasschwingshackl anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT janlhoving anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT svittalkatikireddi anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT beverleyshea anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT reemamustafa anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT mhassanmurad anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT holgerjschunemann anapproachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT joshverbeek approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT paulwhaley approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT rebeccalmorgan approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT kylawtaylor approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT andrewarooney approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT lukasschwingshackl approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT janlhoving approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT svittalkatikireddi approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT beverleyshea approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT reemamustafa approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT mhassanmurad approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper AT holgerjschunemann approachtoquantifyingthepotentialimportanceofresidualconfoundinginsystematicreviewsofobservationalstudiesagradeconceptpaper |
_version_ |
1716862361875251200 |