Confounding

Confounding occurs where the relationship between independent (exposure) and dependent (outcome) variables is distorted by one or more additional, and sometimes unmeasured, variables. A confounding variable must be associated with both the independent and dependent variables but must not be an intermediate step in the relationship between the two (i.e. not on the causal pathway). For example, we know that physical exercise (an independent variable) can reduce a person’s risk of cardiovascular disease (a dependent variable). We can say that age is a confounder of that relationship as it is associated with, but not caused by, physical activity and is also associated with coronary health. See also ‘unobserved heterogeneity’, below.