Role of Covariates in Case Control Studies with Skewed Exposure: Evidence from Monte Carlo Simulations

Case-control studies, a widely used observational study design, are essential for investigating the association between exposure and outcomes. In such studies, logistic regression is commonly employed to analyse the relationship between binary outcome and exposure, accounting for covariates, confou...

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Main Authors: Yashaswini K, Anna Maria Pinto
Format: Article
Language:English
Published: Milano University Press 2025-02-01
Series:Epidemiology, Biostatistics and Public Health
Online Access:https://riviste.unimi.it/index.php/ebph/article/view/27302
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author Yashaswini K
Anna Maria Pinto
author_facet Yashaswini K
Anna Maria Pinto
author_sort Yashaswini K
collection DOAJ
description Case-control studies, a widely used observational study design, are essential for investigating the association between exposure and outcomes. In such studies, logistic regression is commonly employed to analyse the relationship between binary outcome and exposure, accounting for covariates, confounders, and effect modifiers. However, skewed exposure distributions, where the exposure is disproportionately distributed among cases and controls, pose significant challenges. This study aims to address these challenges by conducting a series of Monte Carlo simulation experiments to assess the impact of skewed exposure on the power of the Wald test and the bias in estimated logistic regression coefficients. The simulations focus on the role of continuous covariates in producing reliable estimates of exposure effects. The study highlights the importance of preliminary knowledge of exposure and covariate effects, as these factors play a crucial role in selecting an appropriate sample size. These simulations, which required significant computational time, highlight the robustness of the estimates with larger sample sizes and a greater number of covariates, eliminating the potential bias introduced by skewed exposure.
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spelling doaj-art-e2eaf6318e1c408c8d55c13dd3cc92bc2025-08-20T03:06:10ZengMilano University PressEpidemiology, Biostatistics and Public Health2282-09302025-02-0120110.54103/2282-0930/27302Role of Covariates in Case Control Studies with Skewed Exposure: Evidence from Monte Carlo SimulationsYashaswini K0https://orcid.org/0009-0001-0193-1259Anna Maria Pinto1https://orcid.org/0009-0008-6595-6536Yenepoya University Yenepoya University Case-control studies, a widely used observational study design, are essential for investigating the association between exposure and outcomes. In such studies, logistic regression is commonly employed to analyse the relationship between binary outcome and exposure, accounting for covariates, confounders, and effect modifiers. However, skewed exposure distributions, where the exposure is disproportionately distributed among cases and controls, pose significant challenges. This study aims to address these challenges by conducting a series of Monte Carlo simulation experiments to assess the impact of skewed exposure on the power of the Wald test and the bias in estimated logistic regression coefficients. The simulations focus on the role of continuous covariates in producing reliable estimates of exposure effects. The study highlights the importance of preliminary knowledge of exposure and covariate effects, as these factors play a crucial role in selecting an appropriate sample size. These simulations, which required significant computational time, highlight the robustness of the estimates with larger sample sizes and a greater number of covariates, eliminating the potential bias introduced by skewed exposure. https://riviste.unimi.it/index.php/ebph/article/view/27302
spellingShingle Yashaswini K
Anna Maria Pinto
Role of Covariates in Case Control Studies with Skewed Exposure: Evidence from Monte Carlo Simulations
Epidemiology, Biostatistics and Public Health
title Role of Covariates in Case Control Studies with Skewed Exposure: Evidence from Monte Carlo Simulations
title_full Role of Covariates in Case Control Studies with Skewed Exposure: Evidence from Monte Carlo Simulations
title_fullStr Role of Covariates in Case Control Studies with Skewed Exposure: Evidence from Monte Carlo Simulations
title_full_unstemmed Role of Covariates in Case Control Studies with Skewed Exposure: Evidence from Monte Carlo Simulations
title_short Role of Covariates in Case Control Studies with Skewed Exposure: Evidence from Monte Carlo Simulations
title_sort role of covariates in case control studies with skewed exposure evidence from monte carlo simulations
url https://riviste.unimi.it/index.php/ebph/article/view/27302
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AT annamariapinto roleofcovariatesincasecontrolstudieswithskewedexposureevidencefrommontecarlosimulations