Skip to main content
SpringerLink
Log in
Book cover

Understanding Periodontal Research pp 645–653Cite as

Assessing Confounding and Effect Modification of Periodontitis–Systemic Disease Associations

  • Chapter
  • First Online:

  • 46 Accesses

Abstract

Confounding and effect modification are of increasing importance as periodontal research addresses the putative associations between periodontal disease and systemic diseases. Unfortunately, the importance of confounding and effect modification is not always appreciated and is often overlooked. They may also appear to be similar but they are actually very different. Our goals in controlling them are also different. ‘In epidemiologic analysis one tries to eliminate confounding, but one tries to detect and estimate effect-measure modification’. We also assess effect modification first, since confounding by a variable becomes largely irrelevant if there is also interaction involving that variable.

This is a preview of subscription content, log in via an institution.

References

  • Altman DG, Bland JM. Statistics notes. Treatment allocation in controlled trials: why randomise? BMJ. 1999;318:1209.

    Article  PubMed  Google Scholar 

  • Cleophas TJ, Zwinderman AH, Cleophas TF, Cleophas EP. Statistics applied to clinical trials. 3rd ed. New York: Springer; 2006. p. 235–44.

    Google Scholar 

  • Dietrich T, Hoffmann K. A comprehensive index for the modeling of smoking history in periodontal research. J Dent Res. 2004;83:859–63.

    Article  PubMed  Google Scholar 

  • Dietrich T, Garcia RI, de Pablo P, Schulze PC, Hoffmann K. The effects of cigarette smoking on C-reactive protein concentrations in men and women and its modification by exogenous oral hormones in women. Eur J Cardiovasc Prev Rehabil. 2007;14:694–700.

    Article  PubMed  Google Scholar 

  • Dietrich T, Jimenez M, Krall Kaye EA, Vokonas PS, Garcia RI. Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease. Circulation. 2008;117:1668–74.

    Article  PubMed  Google Scholar 

  • Fitzmaurice G. Confused by confounding? Nutrition. 2003;19:189–91.

    Article  PubMed  Google Scholar 

  • Fitzmaurice G. Adjusting for confounding. Nutrition. 2004;20:594–6.

    Article  PubMed  Google Scholar 

  • Greenland S, Morgenstern H. Confounding in health research. Annu Rev Public Health. 2001;22:189–212.

    Article  PubMed  Google Scholar 

  • Grimes DA, Schulz KF. Clinical research in obstetrics and gynecology: a Baedeker for busy clinicians. Obstet Gynecol Surv. 2002;57(9 Suppl 3):S35–53.

    Article  PubMed  Google Scholar 

  • Hujoel PP, Drangsholt M, Spiekerman C, DeRouen TA. Periodontitis-systemic disease associations in the presence of smoking – causal or coincidental? Periodontol 2000. 2002;30:51–60.

    Article  PubMed  Google Scholar 

  • Hyman J. The importance of assessing confounding and effect modification in research involving periodontal disease and systemic diseases. J Clin Periodontol. 2006;33:102–3.

    Article  PubMed  Google Scholar 

  • Jimenez M, Krall EA, Garcia RI, Vokonas PS, Dietrich T. Periodontitis and incidence of cerebrovascular disease in men. Ann Neurol. 2009;66:505–12.

    Article  PubMed  Google Scholar 

  • Labriola A, Needleman I, Moles DR. Systematic review of the effect of smoking on nonsurgical periodontal therapy. Periodontol 2000. 2005;37:124–37.

    Article  PubMed  Google Scholar 

  • Leffondré K, Abrahamowicz M, Xiao Y, Siemiatycki J. Modelling smoking history using a comprehensive smoking index: application to lung cancer. Stat Med. 2006;25:4132–46.

    Article  PubMed  Google Scholar 

  • MacKinnon DP, Krull JL, Lockwood CM. Equivalence of the mediation, confounding and suppression effect. Prev Sci. 2000;1:173–81.

    Article  PubMed  Google Scholar 

  • Needleman I, Moles DR, Worthington H. Evidence-based periodontology, systematic reviews and research quality. Periodontol 2000. 2005;37:12–28.

    Article  PubMed  Google Scholar 

  • Normand SL, Sykora K, Li P, Mamdani M, Rochon PA, Anderson GM. Readers guide to critical appraisal of cohort studies: 3. Analytical strategies to reduce confounding. BMJ. 2005;330(7498):1021–3.

    Article  PubMed  Google Scholar 

  • Parodi S, Bottarelli E. Controlling for confounding in case–­control studies. Ann Fac Medic Vet Parma. 2005;25:19–46.

    Google Scholar 

  • Pernu HE, Pernu LM, Huttunen KR, Nieminen PA, Knuuttila ML. Gingival overgrowth among renal transplant recipients related to immunosuppressive medication and possible local background factors. J Periodontol. 1992;63:548–53.

    Article  PubMed  Google Scholar 

  • Rothman KJ, Greenland S. Modern epidemiology. 2nd ed. Philadelphia: Lippincott, Williams & Wilkins; 1998.

    Google Scholar 

  • Spiekerman CF, Hujoel PP, DeRouen TA. Bias induced by self-reported smoking on periodontitis-systemic ­disease associations. J Dent Res. 2003;82:345–9.

    Article  PubMed  Google Scholar 

  • Walter C, Kaye EK, Dietrich T. Active and passive smoking: assessment issues in periodontal research. Periodontol 2000. 2012;58:84–92.

    Article  PubMed  Google Scholar 

  • Ylöstalo PV, Knuuttila ML. Confounding and effect modification: possible explanation for variation in the results on the association between oral and systemic diseases. J Clin Periodontol. 2006;33:104–8.

    Article  PubMed  Google Scholar 

  • Yu B, Gastwirth JL. A method of assessing the sensitivity of the Cochran-Mantel-Haenszel test to an unobserved confounder. Philos Transact A Math Phys Eng Sci. 2008;366(1874):2377–88.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Periodontology, University of Tromsø Institute of Clinical Dentistry, Tromsø, Norway

    Alexandrina L. Dumitrescu

  2. Private practice, Bucharest, Romania

    Alexandrina L. Dumitrescu

Authors
  1. Alexandrina L. Dumitrescu
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Dumitrescu, A.L. (2012). Assessing Confounding and Effect Modification of Periodontitis–Systemic Disease Associations. In: Understanding Periodontal Research. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-28923-1_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-28923-1_20

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-28922-4

  • Online ISBN: 978-3-642-28923-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation