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Obesity
Article
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Obesity
Article . 2009 . Peer-reviewed
License: Wiley Online Library User Agreement
Data sources: Crossref
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Response to “Biased Corrections or Biased About Corrections”

Authors: Katherine M, Flegal; Barry I, Graubard; David F, Williamson; Mitchell H, Gail;

Response to “Biased Corrections or Biased About Corrections”

Abstract

The tabulations supplied by Professor Greenberg (1) clarify the procedures that he used in his previous article (2). He calculated the proportion of deaths attributable to obesity within a subgroup that he says had no serious illness. He then multiplied all the deaths in the whole sample by that same proportion to try to estimate the number of obesity-attributable deaths that would have occurred in the whole sample if there had been no serious illness in the whole sample. However, if there had been no serious illness in the whole sample, there would also have been far fewer total deaths (assuming that serious illness increases mortality). Greenberg is calculating deaths attributable to obesity for a hypothetical population that has no persons with serious illness but still has the same numbers of deaths as a population that includes people with serious illness. Thus, his procedure greatly over-estimates the number of obesity-attributable deaths that would occur if there was no serious illness. Although Greenberg calls these estimates the “maximum corrected values” of deaths attributable to obesity, these are not corrected values. His method makes no allowance for any impact of serious illness on mortality and does not correctly calculate the number of obesity-associated deaths that would be predicted if there was no serious illness in the whole sample. In addition, in order for the attributable fraction from the subgroup without serious illness to apply to Greenberg’s hypothetical population without serious illness, that hypothetical whole population would have to have not only BMI-specific hazard ratios identical to those in the subgroup but also a joint distribution of BMI and confounders that was identical to that in the subgroup. Greenberg’s procedure is another variant of the incorrect, partially adjusted method in which relative risks or hazard ratios are adjusted (in this case by stratification) for a confounder (in this case, serious illness), but the effect of the confounder on mortality itself is ignored (3;4). As we noted previously (5), Greenberg’s procedures do not estimate the quantities of interest, cannot be recommended to estimate “corrected” attributable deaths, and have little bearing on the estimates by Flegal et al (6).

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
bronze