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To the Editor:
In this cross-sectional study, Buell et al.1 showed that 25-hydroxyvitamin D [25(OH)D] ≤20 ng/mL indicated a 2.2-fold risk for all-cause dementia, a 2.7-fold risk for Alzheimer disease (AD), and a 2.3-fold risk for stroke. These results remained significant even after adjustment for a list of covariates.
However, adjusting for all potential confounders is essential to determine if the association is really significant or explained by confounders.2 Confounder “C” is defined by 2 conditions: a covariate significantly associated with both the outcomes “Y” and “X”; and the association of “X” with “Y” vanished when adjusting for both “C” and “X.”2 In addition, “C” remains a confounder even when it is not statistically significant by itself because it changes the effect of the exposure of “Y” to “X” when it is included in …
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