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Confounding

Confounding occurs when two risk factors are interrelated and it is incorrectly concluded that one of the factors is causally related to the disease in question. For example, it might be observed that shrimp in ponds with cloudy water do not grow as well as those in clearer water. We might conclude from this that light penetration of the water is important for normal growth. However, it may be that the cloudiness is due to the presence of particular algal species in the water which inhibit growth of the shrimp through toxin production. In this theoretical example, confounding has meant that we have incorrectly concluded that light penetration is associated with poor shrimp growth when the true cause was the presence of toxic algae. The relationships are represented below.