FCM 2
Sources of Error (Dr. Moders)
Specify Ho and Hi, and then perform a test of statistical significance
which will lead to a probability statement or value
P-value: it indicates the probability or likelihood of obtaining a result at
least or extreme as that observed in a study by chance alone, assuming
that there is truly no association between the exposure and outcome
under consideration
In medicine, p-value is set at 0.05
Tests of statistical significance: t-test for continuous variable, x2 test for
discontinuous variable
SOURCES OF ERROR
1. Chance
B.
2. Bias
3. Confounder
A. CHANCE
• Due to random variation from sample to sample.
• Affected by sample size
• Statistical tests to be done to quantify the degree to which
chances variability may account for the results — t test &
chi square test
• P value of ≤0.05 is statistically significant meaning there is no
more than 5%, or 1 in 20 probability of observing a result as
extreme as that observed due solely to chance, then the
association between the exposure & disease is considered
statistically significant.
• If the value is >0.05, chance could not be excluded as a
likely explanation & this findings is not statistically
significant
• P value — it is a composite measure that reflects both
the magnitude of the difference between groups & sample
size
• Even a small difference between groups with large
sample size, p value maybe significant if the difference
between groups is large but sample size is small, so p
value may not be significant
• Confidence interval (Cl) — the range within which the true
magnitude of effect lies with certain degree of assurance. This
is a more informative measures of role of disease
• Effect of sample size in the CI width the narrower the Cl,
the less variability (larger sample size) wider Cl, the
greater the variability in the estimate of effect, the smaller
the sample size
• The larger the study sample, the more stable the
estimate, the narrower the Cl: the wider the Cl, the
greater the variability & the smaller the sample size.
• If the null value of 1.0 is within the CI, the p value is
greater than 0.05
• If the null value of 1.0 Is not within the Cl, the p value is
S0.05
• P value should be considered as a guide to the likelihood that
chance is an explanation of the findings
• No p value, however small exclude chance completely
MR, Mel, Eisa (nagsasawa na akong itype ang name ko!)
Long time ago na, as in 
• No p value, however large, can be taken to mean that the
observe findings was due to chance only; that chance
cannot be excluded as a likely explanation
• The evaluation of role of chance in epidemiologic research
involve performance of a test of statistical significance & the
calculation of p value; confidence interval provides information
concerning the most precise estimate of the true effect
• Tests of statistical significance & confidence intervals evaluate
only the role of chance as an alternative explanation of an
observed association between an exposure and disease
BIAS
• systematic error in an epidemiologic study that results in
incorrect estimate of the association between exposure and
disease
• TYPES OF BIASES:
1. Selection Bias
- occurs if inclusion of members of the groups being
compared (exposed-unexposed for cohort on
diseased-not diseased for case control) depends on
some way on the other variable of interest such that
the relationship between exposure & disease among
the participants among those who are theoretically
eligible to participate are different.
2. Information Bias or Observer Bias
- Systematic differences in the way data on exposure
or outcome are obtained from various groups.
- Types of Information Bias
a. Recall Bias
- Arises when individuals with outcome
remember & report experience differently
from those who had been exposed report
it than those not exposed
- True for case control I retrospective cohort
studies
b. Interviewer Bias
- systematic difference in soliciting,
recording & interpreting of information
from study participants.
- in case-control, it is the ascertainment of
experience where knowledge of outcome
disease might result to differential probing
for previous exposure history (also in
retrospective cohort study)
c. Loss-to-follow-up
- A major source of bias in cohort study
- lf person lost to follow up differ from those
who remain with respect to both exposure
& outcome, any association observed will
be biased
• Misclassification
- subjects are erroneously categorized with respect to
either exposure or disease status
1. When misclassification is random or non- differential
the proportions of subject erroneously classified in
the study groups are approximately equal.
- Random misclassification serve to dilute any
true association between exposure outcome
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 Medicine – Signs and Symptoms of GI Disorder by Dr Guzman Page 2 of 2

2. If the proportion of subjects misclassified differ

between study groups (differential misclassification)
the result will be biased: over or under estimation of
the effect depending on the situation.

C. CONFOUNDER
• It is a mixing of the effect of exposure under study on the
disease with that of the third factor
• Confounder must be associated with the exposure & a risk
factor for the disease
• ‘It could lead to an over estimate or under estimate of the true
association between exposure & disease.
• Can ever change the direction of the observed effect
• The following are true for Confounder
1. The confounder in the association while predictive of
occurrence of disease need not be causal.
2. Confounder must be predictive of the outcome
i. It could be a risk factor by itself even among
unexposed individuals.
ii. It does not only affect the relationship due to its
relationship with exposed factor under study
but by itself is related to the risk of having the
outcome
3. Confounder could not merely be an intermediate link in
the causal chain between exposure & disease under
study
• Methods to Control Confounder in the Design Stage:
1. Randomization
- each individual has the same chance of receiving
each of the possible treatment
2. Restriction
- Restrict the admissibility criteria for subjects & limit
entrance into the study to individuals who fall within
a specified category/ries of the confounder.
- Control of confounders is achieved by selecting into
the study only individuals with certain homogenous
levels of potential confounder
3. Matching
- All levels of factors are allowable for inclusion in the
study but the particular subjects are selected in such
a way that the potential confounder are distributed in
an identical manner among each of the study groups
• Methods to control Confounder in the Analysis Stage:
1. Stratified Analysis
- Control confounder at the analysis wherein it
involves evaluation of association within the
homogeneous categories or strata of the
confounding variables
2. Multivarlate Analysis
- Control confounder simultaneously