Extra

notes for interpretation

(Advanced)
Dr Rachel Thompson, Quality of Medical Practice Convenor
Matt Begun, QMP Tutor
Office of Medical Education
UNSW Medicine
 Confounding
variables/ other
exposure factors

More on interaction and effect modification in

confounding
Further explanation regarding interaction between risk and protective factors
Effect modification = Interaction
This is an advanced concept, so we do not expect you to discuss this in
your group project.
However, it would usually be investigated in epidemiological/public
health studies, as there can be some important effects seen and it can
explain some of your rather odd findings.
When the exposure causes the disease according to different levels of
the confounding variable, then we say that the confounding variable is
actually an effect modifier.
This is usually due to a biological effect.
Usually the interaction is synergistic, but can be the opposite (i.e.
antagonistic).
Interaction/Effect modification = Definition
Interaction occurs when the direction or magnitude of an association
between two variables differs due to the effect of a third variable. It
may reflect a cumulative effect of multiple risk factors which are not
acting independently and produce a greater or lesser effect than the
sum of the effects of each factor acting on its own.
Source: https://www.healthknowledge.org.uk/public-health-textbook/research-methods/1a-
epidemiology/confounding-interactions-methods
Further explanations & examples
Boston Uni School of Public Health Blog on Multivariate analysis:
http://sphweb.bumc.bu.edu/otlt/mph-
modules/bs/bs704_multivariable/BS704_Multivariable4.html

One way to analyse this effect (which we dont recommend as you

dont have time!) is to stratify by the potential modifier and see if the
OR are different for the outcome (DV) and the other risk/protective
factor (e.g. Main IV) See the section on effect modification in this
page, which also has some good examples:
https://onlinecourses.science.psu.edu/stat507/node/34