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2017 ; 9
(ä): 185-193
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Confounding in observational studies based on large health care databases:
problems and potential solutions - a primer for the clinician
#MMPMID28405173
Nørgaard M
; Ehrenstein V
; Vandenbroucke JP
Clin Epidemiol
2017[]; 9
(ä): 185-193
PMID28405173
show ga
Population-based health care databases are a valuable tool for observational
studies as they reflect daily medical practice for large and representative
populations. A constant challenge in observational designs is, however, to rule
out confounding, and the value of these databases for a given study question
accordingly depends on completeness and validity of the information on
confounding factors. In this article, we describe the types of potential
confounding factors typically lacking in large health care databases and suggest
strategies for confounding control when data on important confounders are
unavailable. Using Danish health care databases as examples, we present the use
of proxy measures for important confounders and the use of external adjustment.
We also briefly discuss the potential value of active comparators,
high-dimensional propensity scores, self-controlled designs, pseudorandomization,
and the use of positive or negative controls.