BIOETHICS 1

Semester
Bias in Research
Dr. Ronwaldo San Diego& Dr. Macario Reandelar jr|Feb 17,2018

2. Selection bias- the sample being unrepresentative of
I. What is Bias? the target population
A. Threats to Validity in the Conclusion 3. Confounding- the effects of other determinants on
B. BIAS the association of interest
1. Information Bias
2. Selection Bias 1. INFORMATION BIAS
i. Source of selection bias Sources of information bias:
3. Confounding
• Faulty measuring instruments
i. In the design stage
ii. In the analysis stage • Different standards in different biochemical
iii. Random Error laboratories
II. Reference • Errors by clinicians in diagnosing diseases
• Bias by investigators consciously or unconsciously
reporting more favourable results for treatments
I. WHAT IS BIAS? they believe in
• Defines as any tendency which prevents unprejuced • Biased reporting of symptoms by patients wishing to
consideration of a question an any trends or please doctors treating them
deviation from the truth • Memory lapses by subjects in case-control studies
o Data collection asked to recall past exposure to a risk factor (RECALL
o Data analysis BIAS)
o Interpretation publication • No validated definition of a variable
o Review of data • Not validated questionnaire
• Intentionally or unintentional • May be reduced or eliminated by good study design
• A systematic distortion of association between a • Blinding of both investigators and subjects, until
determinant and an outcome due to a deficiency in after the response has been evaluated, (DOUBLE
the study design BLIND)
• Threat to validity in the conclusion • If the evaluators know the treatment allocation but
A. THREATS TO VALIDITY IN THE CONCLUSION the subjects do not, the study is said to be single
• In a research when we want to look into the blind
relationship between an independent variable and a • Memory laps
dependent variable, between an exposure and an Examples: mothers of children with birth defects are likely to
outcome, between a risk factor and a disease, major remember drugs they took during pregnancy differently that
threats to the validity of such a study can arise. mother of normal children (maternal Bias)
• These threats should always be considered as
alternative explanations in the interpretation of the
results
• Two error factors constitute these major threats of a
study:
1. The systematic error (bias), and
2. Chance error or random (sampling
variability)

B. BIAS
• Any trend in the collection, analysis, interpretation,
publication or review of data that can lead to
conclusions from the truth.
• A systematic distortion of the association between a
determinant and an outcome due to a deficiency in
the study design.


Types of Bias
May arise due to:
1. Information bias- poor measurement

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BIOETHICS 1
Bias in Research
2. SELECTION BIAS In this example, hospital controls do not represent
• Occurs when there is a systematic difference the prevalence of exposure (smoking) in the
between the characteristics of those selected for the community from which cases of chronic lung disease
study and those who are not arise. The exposure-disease arise. The exposure-
• Occurs when the exposure status influences the disease association has been distorted by selection
likelihood of subjects being enrolled in the study of hospital controls

Sources of selection bias 3. CONFOUNDING
• Survival and loses to follow-up differ in the two • Confounding is one of the most intriguing biases that
exposure groups being compared can occur in epidemiologic research
• Volunteer and non-response bias- Individuals who • It arises whenever an outcome has two
volunteer for a study may possess different determinants which are themselves associated, and
characteristics than the average individual in the one is omitted from consideration.
target population. • Bias involves error in the measurement of a variable.
• Bias will be introduced if the association between • Confounding involves error in the interpretation of
exposure an disease differs between study what may be an accurate measurement.
volunteers and non-responders Two necessary criteria for a variable to explain such
• Hospital patient bias (Berkson’s Bias)- bias may differences in risk (and hence explain confounding) are:
occur when hospital controls are used in a case 1. It must be a risk factor for the disease among the
control study unexposed. That is, the association between the
• Healthy worker effect- Generally, working confounding factor and the disease is independent
individuals are healthier than individuals who are not of the exposure.
working. 2. It must be associated with the exposure variable.
• In Intervention studies- occurs when there are
systematic differences between comparison groups
in response to treatment or prognosis.
Main Outcome

Determinant Variable

Variable




Confounding
Variable



Control of confounders can be done either of two ways:
1. In the design stage
2. In the analysis stage

In the design stage:
• Restriction
• Matching
Example:
• Randomization
In a case-control study of smoking and chronic lung

disease, the association of exposure with disease will
In the Analysis stage
tend to be weaker if controls are selected from a
• Stratified analysis
hospital population (because smoking causes many
• Multivariate analysis
diseases resulting in hospitalization) than if controls

are selected from the community.




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BIOETHICS 1
Bias in Research
Example of Confounding:
LUNG CA NO LUNG CA

ALCOHOLIC 60 40

NON-ALCOHOLIC 40 60

EXAMPLE OF CONFOUNDING
• Smoking can be a confounder in the supposed
relationship between alcohol consumption and lung
CA
• Smoking is both related to alcoholism and Lung CA

RANDOM ERROR
• The difference between between the estimate and
the parameter
• Also known as chance error
• Odd Ratio = 1.08
• Odds ratio is greater than 1 but may not be
statistically significant.
• The reason for the supposed relationship may be
due to chance error


PASOK MOIRA!!!!

REFERENCE
1. Lecture of Dr Ronwaldo San Diego
2. Lecture of Dr Macario Reandelar jr

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