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JAMA Guide to Statistics and Methods
November 1, 2016

Confounding by Indication in Clinical Research

Author Affiliations
  • 1Departments of Emergency Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
  • 2Senior Editor, JAMA
  • 3Department of Emergency Medicine, Harbor-UCLA Medical Center and David Geffen School of Medicine at UCLA, Los Angeles, California
JAMA. 2016;316(17):1818-1819. doi:10.1001/jama.2016.16435

In the assessment of the effect of a treatment or potential risk factor—termed an exposure—on a patient outcome, the possibility of confounding by other factors must be considered.1 For example, if researchers studied the effect of coffee drinking on the development of lung cancer, they might observe an apparent association between these 2 variables. However, because drinking coffee is also related to smoking, the observed association between coffee drinking and lung cancer does not represent a true causal relationship but is rather the result of the association of coffee drinking with smoking—the confounder—which is the true cause of lung cancer.