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A Method to Detect Residual Confounding in Spatial and Other Observational Studies

Flanders, W. Danaa,b; Klein, Mitchelc; Darrow, Lyndsey A.c; Strickland, Matthew J.c; Sarnat, Stefanie E.c; Sarnat, Jeremy A.c; Waller, Lance A.b; Winquist, Andreac; Tolbert, Paige E.c

doi: 10.1097/EDE.0b013e3182305dac

Background: Residual confounding is challenging to detect. Recently, we described a method for detecting confounding and justified it primarily for time-series studies. The method depends on an indicator with 2 key characteristics: (1) it is conditionally independent (given measured exposures and covariates) of the outcome, in the absence of confounding, misspecification, and measurement errors; and (2) like the exposure, it is associated with confounders, possibly unmeasured. We proposed using future exposure levels as the indicator to detect residual confounding. This choice seems natural for time-series studies because future exposure cannot have caused the event, yet they could be spuriously related to it. A related question addressed here is whether an analogous indicator can be used to identify residual confounding in a study based on spatial, rather than temporal, contrasts.

Methods: Using directed acyclic graphs, we show that future air pollution levels may have the characteristics appropriate for an indicator of residual confounding in spatial studies of environmental exposures. We empirically evaluate performance for spatial studies using simulations.

Results: In simulations based on a spatial study of ambient air pollution levels and birth weight in Atlanta, and using ambient air pollution 1 year after conception as the indicator, we were able to detect residual confounding. The discriminatory ability approached 100% for some factors intentionally omitted from the model, but was very weak for others.

Conclusion: The simulations illustrate that an indicator based on future exposures can have excellent ability to detect residual confounding in spatial studies, although performance varied by situation.


From the Departments of aEpidemiology, bBiostatistics and Bioinformatics, and cEnvironmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, GA.

Submitted 10 February 2011; accepted 17 May 2011.

Supported by EPA STAR RD83479901 and RD833626, NIEHS R01ES11294, and EPRI EP-P27723/C13172.

The views expressed in this document are solely those of the authors and do not necessarily reflect the views of the funding agencies, and mention of any products or commercial services does not constitute endorsement.

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Correspondence: W. Dana Flanders, Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.