ArticleClinical epidemiology2017
Confounding in observational studies based on large health care databases: problems and potential solutions - a primer for the clinician.
Article in Clinical epidemiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 93 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
93 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Maternal and neonatal outcomes among women with suspected macrosomia undergoing induction of labor: a systematic review and meta-analysis.Frontiers in global women's health · 2026Pooled it
- Clinical outcomes of early vs. late extubation following cardiac surgery: a systematic review and meta-analysis.Frontiers in medicine · 2026Pooled it
- Artificial intelligence-assisted endobronchial ultrasound for differentiating between benign and malignant thoracic lymph nodes: a meta-analysis.BMC pulmonary medicine · 2025Pooled it
- Systemic immune-inflammation index and the short-term mortality of patients with sepsis: A meta-analysis.Biomolecules & biomedicine · 2025Pooled it
- Diabetes and anti-diabetic interventions and the risk of gynaecological and obstetric morbidity: an umbrella review of the literature.BMC medicine · 2023Pooled it
- Methodological approaches to measuring the incidence of unplanned emergency department presentations by cancer patients receiving systemic anti-cancer therapy: a systematic review.BMC medical research methodology · 2022Pooled it
- The association of birth by caesarean section and cognitive outcomes in offspring: a systematic review.Social psychiatry and psychiatric epidemiology · 2021Pooled it
- Negative Pregnancy Experiences and Psychological Distress: Associations with Active Coping and Marital Satisfaction.Medicina (Kaunas, Lithuania) · 2026Article
- Assessment of real-world evidence research competencies in federated research networks: a maternal health fellowship program evaluation.JAMIA open · 2026Article
- Impact of Surgical Timing on Hospital Length of Stay Following Hemiarthroplasty and Internal Fixation for Hip Fractures: A Six-Year Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Investigating Performance, Functional Outcomes, and Patient Autonomy in a Rural Community Hospital: A Real-Life Descriptive Cohort Study of Territorial Intermediate Care.Healthcare (Basel, Switzerland) · 2026Article
- Letter to the Editor regarding "Questionable indication for postoperative radiotherapy after surgery for metastases of the major long bones": A cautionary note on methodology and analysis.Journal of bone oncology · 2026Article
- Epicardial adipose tissue signatures in Asian coronary artery disease: Insights from cardiac CT.American journal of preventive cardiology · 2026Article
- Persistently Elevated Gamma-Glutamyl Transferase and Hepatobiliary Malignancies: A Real-World Cohort Study.Cancers · 2026Article
- Real World Evidence Versus Randomised Controlled Trials: Is the Future of Nutritional Sciences Research in Electronic Health Records?Nutrition bulletin · 2026Review
- The Clinical Impact of Early Steroid Withdrawal on Diabetes Mellitus After Liver Transplantation: A Population-Based Cohort Study.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Multi-omics Data Integration.Advances in experimental medicine and biology · 2026Review
- Outline: The Long-Term Impact of Exercise on Adolescent Growth and Development.Advances in experimental medicine and biology · 2026Review
- Chronic Back Pain Increases Alzheimer's Disease Risk Independent of Gross Brain Structural Alterations: Genetic Evidence from Two Populations.Journal of pain research · 2026Article
- Health beliefs and their relation to household, necessary, and unnecessary contacts across COVID-19 epidemic waves in Taiwan.BMC public health · 2025Article
33 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Population-based health care databases are a valuable tool for observational studies as they reflect daily medical practice for large and representative populations. A constant challenge in observational designs is, however, to rule out confounding, and the value of these databases for a given study question accordingly depends on completeness and validity of the information on confounding factors. In this article, we describe the types of potential confounding factors typically lacking in large health care databases and suggest strategies for confounding control when data on important confounders are unavailable. Using Danish health care databases as examples, we present the use of proxy measures for important confounders and the use of external adjustment. We also briefly discuss the potential value of active comparators, high-dimensional propensity scores, self-controlled designs, pseudorandomization, and the use of positive or negative controls.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.