Study did not take account of confounders

BMJ 1996;313:1142-1143 (2 November)

Letters

Study did not take account of confounders

EDITOR,--We welcome the approach taken by P D P Pharoah andW Hollingworth in using life tables to evaluate the cost effectivenessof reducing cholesterol concentration.¹ This approach has beenwidely used elsewhere² and is a valuable technique for evaluatinghealth service interventions aimed at modifying the risk profilesof a population. Unfortunately, however, their analysis maybe flawed as such analyses depend on obtaining an accurate assessmentof the overall manner in which population death rates are influencedby the intervention being evaluated. Such relations are extremelycomplex as they must take account of behavioural factors thatmay confound the impact of the health intervention. In thiscase three such factors must be taken into account.

Firstly, a lifestyle that leads to high cardiovascular risk(poor diet, smoking, etc) will also increase the risk of prematuredeath generally. This undermines the assumption of Pharoah andHollingworth that people with . . . [Full text of this article]

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Relevant Article

Cost effectiveness of lowering cholesterol concentration with statins in patients with and without pre-existing coronary heart disease: life table method applied to health authority population: P D P Pharoah and W Hollingworth
BMJ 1996 312: 1443-1448. [Abstract] [Full Text]