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Our database lacks robust capture of certain potential confounders, such as body mass index.
The team acknowledges several limitations to this study, including recall bias and the inability to adjust for certain potential confounders.
By linkage to nationwide health registers, the CopDiff will have the capability to assess the prognostic value of the DIFFs for several clinical outcomes, while adjusting for certain potential confounders.
The presence of certain potential confounders pertinent to investigating hypotheses on a link between BCG vaccination and chronic diseases was verified, given that a typical limitation of using administrative databases for research purposes is the lack of information on such variables.
In addition, when assessing the longitudinal effects of changes in a MRI finding on symptom outcomes, each participant effectively serves as their own control, reducing the effect of certain potential confounders that may differ among individuals but which do not vary over time for a participant [ 6].
Another concern is that we lacked information regarding certain potential confounders, including hormonal, reproductive, anthropometric, and lifestyle factors, that may be associated with both different histologic types of breast cancer and with the different clinical and pathologic tumour characteristics we evaluated.
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Most known confounders, based on previous literature, were controlled for, but we cannot be certain that all potential confounders were measured.
Braun et al. (2006) noted that their analyses were limited by the cross-sectional nature of the National Health and Nutrition Examination Survey data they used, precluding adjustment of their model for certain covariates and potential confounders (e.g., parental psychopathology).
We also considered certain other drugs as potential confounders, including postmenopausal hormone replacement therapy (HRT), statins, antihistamines, and anti-asthma medications (ATC codes in Appendix).
Finally, controlling for confounding in cross-sectional research is often difficult because we cannot be certain whether the potential confounder is a result of the exposure-outcome association or truly associated with the exposure before the outcome develops [ 13].
Certain aspects of socioeconomic status were potential confounders in our analyses (UKCCS Investigators, 2000).
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com