Professional Documents
Culture Documents
L Tn Phng*
Nhiu (Confounding)
Khi nim
Nhiu lm thay i, lm sai lch mi lin quan thc s gia phi nhim v hu qu (exposure and outcome). Nhiu l vn rt quan trng trong dch t hc v n c th lm sai lch trong suy on nguyn nhn v hu qu.
nh ngha nhiu
Nhiu (confounding) l tc ng hn hp (effect mixing). Cc tc ng ny bao gm tc ng ca phi nhim i vi hu qu, v tc ng ca mt yu t th ba (gi l yu t gy nhiu: confounder) cng i vi hu qu . Ni cch khc: Nu gi x l tc ng ca phi nhim i vi hu qu, y l tc ng ca yu t th ba i vi hu qu, th nhiu l hn hp ca x v y. Nhiu xy ra khi 2 nhm phi nhim v khng phi nhim khng tng ng nhau v cc yu t khc. V d, khi so snh ung th phi (bnh) vi ht thuc l (phi nhim), nhiu c th xy ra nu 2 nhm c ht thuc v khng ht thuc khng tng ng nhau v tui, gii, ngh nghip, dn tc, ni sinh sng v.v... V d 1: Ngi ta quan st thy b m c cng nhiu con th c nguy c sinh ra mt a con b hi chng Down. Nh vy, mi quan h nhn qu gia c nhiu con v nguy c mc hi chng Down ca tr l mi quan h nhn qu thc s hay l do yu t th ba no khc gy nhiu? Trn thc t, b m cng c nhiu con th tui cng ln. Vy tui ca b m c th l yu t gy nhiu ln mi quan h gia s con v nguy c mc bnh Down ca tr. V d 2: Ngi ta quan st thy nguy c ung th ty tng cao hn nhng ngi ung c ph nhiu (nghin cu ca MacMahon v cng s, 1981). Nhng nhng ngi ht thuc l th cng thng km theo ung c ph nhiu. Vy c phi thc s l c mi quan h gia ung c ph v ung th ty tng, hay mi quan h ny b lm nhiu bi ht thuc l cng l mt trong nhng nguy c gy ung th ty tng?
Nhiu (Confounder)
Hu qu (Outcome)
Nhiu khng phi l sai st (errors) ca nghin cu. Ngc li, n c gi tr khi c m t trong nghin cu. Do , khng m t v gii thch cc yu t nhiu c th c trong nghin cu mi l sai st ca nghin cu.
Tng tc (Interaction)
nh ngha tng tc
Khi c s hin din ca 2 hay nhiu yu t nguy c cng tc ng m t l hin mc (incidence rate) ca mt bnh khc vi cc t l hin mc ca bnh khi ch hin din tng yu t nguy c ring l, th ta ni l c s tng tc gia cc yu t nguy c i vi bnh . Ni d hiu hn, trong iu kin c nhiu yu t nguy c cng tc ng n mt bnh, tng tc xy ra khi nh hng tng hp ca cc yu t khng tng ng vi nh hng ca tng yu t mt. Nu nh hng tng hp l ln hn, ta gi l cng hng (synergism). Nu nh hng tng hp l nh hn, ta gi l i khng (antagonism).
Phn tch ny s tnh ton c OR (hoc RR) cho tng tng, OR (RR) th, v OR (RR) hiu chnh (adjusted) m ph bin nht l dng phng php Mantel Haenszel. im khng thun tin ca phng php ny l s to ra rt nhiu tng khc nhau khi c nhiu hn 2 bin nhiu cn phn tch. Phn tch hi quy (thng l multiple regression): Phng php ny ngy cng ph bin v thay th cho phng php phn tng, nht l khi phi kim sot nhiu bin nhiu khc nhau.
Phn tch th
Phn tng
Khng
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Khng
Tng tc
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Nhiu
TI LIU THAM KHO CHNH Ahrens, W., & Pigeot, I. (2004). Hand book of Epidemiology. Bremen: Springer. Leon, G. (2009). Epidemiology (4rd ed.). Philadelphia: W.B. Saunders Company.