ArticleEnvironment international2021
An approach to quantifying the potential importance of residual confounding in systematic reviews of observational studies: A GRADE concept paper.
Article in Environment international, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 2 of them syntheses that pooled it.
What it found
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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.
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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.
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Who cites it
25 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Oncovascular Resection in Pelvic Exenteration: A Systematic Review.ANZ journal of surgery · 2026Pooled it
- Eating disorder-related electrolyte abnormalities and adverse outcomes: A systematic review and meta-analysis.PloS one · 2026Pooled it
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- Neurophysiological Characterization of ADHD in Children Using EEG Signals: A Machine Learning Approach to Executive Function Networks.Sensors (Basel, Switzerland) · 2026Article
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- GRADE concept article: Evaluating risk of bias in a body of evidence from studies of environmental and other exposures.Environment international · 2026Article
- Associations of dietary diversity trajectories with depressive symptoms among Chinese older adults: a 10-year longitudinal study.Frontiers in nutrition · 2026Article
- Associations between precipitation, temperature, and malaria prevalence in children under 5 in Mali.PloS one · 2026Article
- Assessment of GRADE utilisation in published systematic review and meta-analysis.Indian journal of anaesthesia · 2026Article
- TriNetX and Real-World Evidence: A Critical Review of Its Strengths, Limitations, and Bias Considerations in Clinical Research.ASIDE internal medicine · 2025Article
- Ureaplasma in neonatal gastric fluid contributing to bronchopulmonary dysplasia.BMC pulmonary medicine · 2025Article
- A doubly robust estimator for continuous treatments in high dimensions.BMC medical research methodology · 2025Article
- Increasing the utility of epidemiologic studies as key evidence in chemical risk assessment.Toxicological sciences : an official journal of the Society of Toxicology · 2025Article
- Phenome-wide Analysis of Diseases in Relation to Objectively Measured Sleep Traits and Comparison with Subjective Sleep Traits in 88,461 Adults.Health data science · 2025Article
- Nutrition Users' Guides: an introduction to structured guides to evaluate the nutrition literature.BMJ nutrition, prevention & health · 2025Review
- Insulin resistance and its association with coronary heart disease: insights from bioinformatics analysis.Frontiers in endocrinology · 2025Article
- Association of Maternal Air Pollution Exposure and Infant Lung Function Is Modified by Genetic Propensity to Oxidative Stress.Children (Basel, Switzerland) · 2024Article
- The effects of deep brain stimulation on sleep: a systematic review and meta-analysis.Sleep advances : a journal of the Sleep Research Society · 2024Review
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13 authors.
Funding
Abstract
Small relative effect sizes are common in observational studies of exposure in environmental and public health. However, such effects can still have considerable policy importance when the baseline rate of the health outcome is high, and many persons are exposed. Assessing the certainty of the evidence based on these effect sizes is challenging because they can be prone to residual confounding due to the non-randomized nature of the evidence. When applying GRADE, a precise relative risk >2.0 increases the certainty in an existing effect because residual confounding is unlikely to explain the association. GRADE also suggests rating up when opposing plausible residual confounding exists for other effect sizes. In this concept paper, we propose using the E-value, defined as the smallest effect size of a confounder that still can reduce an observed RR to the null value, and a reference confounder to assess the likelihood of residual confounding. We propose a 4-step approach. 1. Assess the association of interest for relevant exposure levels. 2. Calculate the E-value for this observed association. 3. Choose a reference confounder with sufficient strength and information and assess its effect on the observed association using the E-value. 4. Assess how likely it is that residual confounding will still bias the observed RR. We present three case studies and discuss the feasibility of the approach.
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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.