title: Selection bias and patterns of confounding in cohort studies: the case of the NINFEA web-based birth cohort.
abstract: BACKGROUND
  Several studies have examined the effects of sample selection on the exposure-outcome association estimates in cohort studies, but the reasons why this selection may induce bias have not been fully explored.
  
  
  OBJECTIVE
  To investigate how sample selection of the web-based NINFEA birth cohort may change the confounding patterns present in the source population.
  
  
  METHODS
  The characteristics of the NINFEA participants (n=1105) were compared with those of the wider source population-the Piedmont Birth Registry (PBR)-(n=36 092), and the association of two exposures (parity and educational level) with two outcomes (low birth weight and birth by caesarean section), while controlling for other risk factors, was studied. Specifically the associations among measured risk factors within each dataset were examined and the exposure-outcome estimates compared in terms of relative ORs.
  
  
  RESULTS
  The associations of educational level with the other risk factors (alcohol consumption, folic acid intake, maternal age, pregnancy weight gain, previous miscarriages) partly differed between PBR and NINFEA. This was not observed for parity. Overall, the exposure-outcome estimates derived from NINFEA only differed moderately from those obtained in PBR, with relative ORs ranging between 0.74 and 1.03.
  
  
  CONCLUSIONS
  Sample selection in cohort studies may alter the confounding patterns originally present in the general population. However, this does not necessarily introduce selection bias in the exposure-outcome estimates, as sample selection may reduce some of the residual confounding present in the general population.
authors.affiliation: Cancer Epidemiology Unit, CeRMS and CPO-Piemonte, University of Turin, Via Santena 7, Turin 10126, Italy. costanza.pizzi@lshtm.ac.uk
authors.forename: Costanza
authors.initials: C
authors.lastname: Pizzi
authors.forename: Bianca L
authors.initials: BL
authors.lastname: De Stavola
authors.forename: Neil
authors.initials: N
authors.lastname: Pearce
authors.forename: Fulvio
authors.initials: F
authors.lastname: Lazzarato
authors.forename: Paola
authors.initials: P
authors.lastname: Ghiotti
authors.forename: Franco
authors.initials: F
authors.lastname: Merletti
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Richiardi
mesh_terms: D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D020407:Internet; D018579:Patient Selection; D011247:Pregnancy; D012107:Research Design; D012307:Risk Factors; D015983:Selection Bias