8/14/2018

Validity and Bias

Community Medicine Dept.

Sam Ratulangi Medical School - Unsrat

Man prefers to believe what he prefers

to be true.
Francis Bacon
 https://www.goodreads.com/quotes/63465-man-prefers-to-believe-what-
he-prefers-to-be-true

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Terms and definitions

Validity
The degree to which inferences drawn from a
study are valid.
 (Porta, 2014, A dictionary of epidemiology, 6th ed.)
Relative absence of bias or systematic error.
 (Porta, 2008, A dictionary of epidemiology, 5th ed)

Terms (cont.)

Validity…
The degree to which the data measure what
they were intended to measure.
 (Fletcher, 2014, Clinical epidemiology: the essentials,
5th ed.)
The degree to which the studies meet basic
logical criteria for absence of bias.
 (Greenland, 2015, Oxford Textbook of Global Public
Health, 6th ed.)

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Terms (cont.)

Internal validity
The degree to which a study is free from bias or
systematic error.
External validity = Generalizability,
transportability
The degree to which results of a study may apply, be
generalized, or be transported to populations or
groups that did not participate in the study
(Porta, 2014, A dictionary of epidemiology, 6th ed.)

Confounding
Loosely, the distortion of a measure of the effect
of an exposure on an outcome due to the
association of the exposure with other factors
that influence the occurrence of the outcome.

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Terms (cont.)

Bias = Systematic error

Systematic deviation of results or inferences
from truth.
 Processes leading to such deviation. An error in the
conception and design of a study—or in the
collection, analysis, interpretation, reporting,
publication, or review of data—leading to results or
conclusions that are systematically (as opposed to
randomly) different from truth

Terms (cont.)

Precision
Relative lack of random error.
 Contrast with internal validity
 >< imprecision = random error
 P-value
 Confidence interval

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Systematic and Random Error

Gerstman, 2013, Epidemiology kept simple.

THREATS TO VALIDITY

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Bias and confounding

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List of Bias

Incidence-Prevalence (Neyman) Bias

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Incidence-Prevalence (Neyman) Bias

Incidence-Prevalence (Neyman) Bias

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Incidence-Prevalence (Neyman) Bias

Incidence-Prevalence (Neyman) Bias

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Incidence-Prevalence (Neyman) Bias

“A late look at those exposed (or affected)

early will miss fatal and other short
episodes, plus mild or silent cases and cases
in which evidence of exposure disappears
with disease onset.”
Sackett, 1979, Bias in analytic research.

Admission rate (Berkson’s) Bias

“If the admission rates of exposed and

unexposed cases and controls differ. their
relative odds of exposure to the putative
cause will be distorted in hospital-based
studies.”
Sackett, 1979, Bias in analytic research.

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Admission rate (Berkson’s) Bias

Streiner, 2009, PDQ epidemiology.

Admission rate (Berkson’s) Bias

Streiner, 2009, PDQ epidemiology.

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Response/Volunteer Bias

Systematic error due to differences in

characteristics between those who
volunteer, choose, or accept to take part in a
study and those who do not.
Compliance bias
Occurs among participants of trials.

Others
Hawthorne Effect
Blinding
Proxy Measures
Confounding & Interaction
Recall Bias
Ecologic Fallacy
Age-Period-Cohort Effects
Length Bias
Lead-Time Bias

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Questions?

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