Chapter 9 · Regression models
When predictors overlap, which one matters?
Multicollinearity, variance inflation factor, variable selection, overfitting and interaction terms.
Read first: Correlation and regression, Bias, confounding and validity
The problem first
You are an MD Physiology resident studying systolic BP in 50 adults. Age alone and weight alone each predict it. You enter age, weight, BMI and waist circumference together. The model is highly significant (F(4, 45) = 14.9, p < 0.001, R² = 0.57), but weight, BMI and waist each have p > 0.2, and the coefficient for weight is now negative: −0.31 mmHg per kg.
Your co-guide reads the table and asks one question.
“Does gaining weight lower blood pressure?”
Start here
What is multicollinearity?
Multicollinearity means that one predictor can be predicted well from the other predictors in the model. The data then carry little information about the effect of that predictor with the others held constant.
In the multiple regression chapter, the age coefficient was estimated from the part of age that duration of diabetes did not explain. When a predictor is almost fully explained by the others, that part is small and its coefficient is imprecise.
- Collinear predictors lie close to one straight line when plotted against each other. Multicollinearity covers a predictor that is close to a combination of several others. The term was first introduced by Ragnar Frisch in 1934.
- Perfect collinearity: one predictor is an exact linear combination of others, such as systolic BP, diastolic BP and pulse pressure. The coefficients cannot be estimated. SPSS will not enter a variable whose tolerance is below its default of 0.0001.
- It is a property of the predictors in your sample, not of the outcome. A study that recruits patients with a wide range of both predictors has less of it.
Consequences
What does multicollinearity do to the results?
It makes the coefficients of the overlapping predictors unstable and imprecise. The model as a whole, and its predictions, are affected much less.
- Inflated standard errors: the SE of the BMI coefficient is 0.36 with age and BMI in the model, and 1.85 with weight and waist added, 5.2 times larger.
- Wide confidence intervals: BMI 2.11 (95% CI 1.39 to 2.83) becomes 2.07 (−1.66 to 5.81).
- Coefficients that change sign: weight alone +0.54 mmHg per kg (0.24 to 0.84). With age and BMI added, −0.35 (−0.86 to 0.16).
- A significant model with no significant predictor: weight, BMI and waist together F(3, 45) = 12.33, p < 0.001, while their individual p values are 0.24, 0.27 and 0.54.
- Coefficients that change when a patient or a predictor is added or removed.
- Fit and predictions barely change: adjusted R² is 0.532 with all four predictors and 0.529 with age and BMI alone.
Kim (2019) summarises the mechanism: the variance of a coefficient is proportional to its VIF. “The larger σh2 produces unreliable probability values and confidence intervals of the regression coefficients.”
Interactive
Raise the correlation between two predictors and watch the standard errors and sign flips grow
Try this: move the correlation from 0 to 0.95. Watch the dots spread out, the confidence interval widen, and some studies give a negative coefficient for a predictor whose true effect is positive.
Simulation: 200 studies of 50 patients each. In every study both predictors truly raise the outcome by 0.5 units per unit. Only the correlation between the two predictors changes.
VIF = 1 ÷ (1 − r²) when there are two predictors
At r = 0.00, the average 95% confidence interval for coefficient 1 is 0.58 units wide (true value 0.5). Coefficient 1 reached p < 0.05 in 90% of studies. √VIF = 1.00, so collinearity alone multiplies the standard error by about 1.0.
Detection
How do you detect multicollinearity?
Start with the correlations between predictors, then calculate a variance inflation factor (VIF) for every predictor. Pairwise correlations alone can miss it.
VIFj = 1 ÷ (1 − R²j) tolerancej = 1 − R²j = 1 ÷ VIFj
- R²ⱼ
- R² from regressing predictor j on all the other predictors (the outcome is not used)
- VIF
- how many times larger the variance of coefficient j is than it would be if predictor j were unrelated to the others
- √VIF
- how many times larger the standard error is: VIF 4 doubles it, VIF 9 triples it
- Correlation matrix: look for pairs above about 0.8. It misses a predictor explained by several others together. In the teaching data BMI correlates only 0.06 with height, but with all five predictors (age, weight, BMI, waist, height) in the model its VIF is 234.
- VIF and tolerance: full teaching model: age 1.02, weight 5.31, BMI 26.80, waist 18.34 (tolerance for BMI 0.037). Kim (2019): “Multicollinearity is present when the VIF is higher than 5 to 10”. A VIF above 10 has been attributed to Marquardt (1970) as the level not to exceed.
- Condition index and condition number: the square root of the largest eigenvalue of the predictors' correlation matrix divided by each eigenvalue. The largest is the condition number. Kim (2019) gives 10 to 30 as the threshold. Teaching model: 11.1. SPSS reports condition indices from the eigenvalues of the scaled and uncentered cross-products matrix, a different calculation that gives different values, so check which version your software reports.
- Variance decomposition proportions: they identify which predictors overlap. Kim (2019): when two or more proportions above 0.8 to 0.9 belong to the same condition index above 10 to 30, those predictors are multicollinear.
- Warning signs in the output: large SEs, a coefficient with the opposite sign to its unadjusted value or to clinical knowledge, and coefficients that change a lot when one predictor is added or removed.
Interactive
Choose the predictors and watch each VIF, standard error and sign
Try this: start with age and weight. Tick BMI, then waist. Watch the VIF column, the standard error of BMI, and the sign of the weight coefficient.
Teaching example, made-up data: systolic BP (mmHg) in 50 adults. Least squares fitted in your browser.
| Predictor | B | SE | 95% CI | p | VIF | Tolerance |
|---|---|---|---|---|---|---|
| Age (years) | 0.73 | 0.18 | 0.38 to 1.08 | < 0.001 | 1.0 | 1.000 |
| Weight (kg) | 0.53 | 0.13 | 0.27 to 0.79 | < 0.001 | 1.0 | 1.000 |
Every VIF is below 2: the chosen predictors overlap very little.
| r | Age | Weight |
|---|---|---|
| Age | 1 | 0.01 |
| Weight | 0.01 | 1 |
What to do
When predictors overlap, which one matters?
The data cannot answer that question. The answer has to come from the study question and clinical knowledge, and it should be decided before you look at the p values.
- Check whether it matters for your question. Collinearity inflates only the SEs of the overlapping predictors. In the teaching data, age had VIF 1.02 and an SE of 0.157 with all three body-size measures in the model, against 0.155 with BMI alone. If the exposure you care about has a low VIF, overlap among adjustment variables does not harm its estimate.
- Choose one measure when several measure the same thing. With age and BMI only: BMI 2.11 mmHg per kg/m² (1.39 to 2.83), every VIF 1.00, adjusted R² 0.529.
- Combine them into one score decided in advance. The mean of the z-scores of weight, BMI and waist gave 9.63 mmHg per SD of the score (6.12 to 13.14), adjusted R² 0.505.
- Centre continuous variables before forming product or squared terms (next section).
- Keep a real confounder even if its VIF is high. Removing it lowers the VIF and biases the exposure estimate.
- Collect more information: a larger sample, or patients with a wider range of both predictors, gives smaller SEs.
- Penalised methods such as ridge regression (Hoerl and Kennard, 1970) accept a little bias in exchange for smaller variance. Use them with a statistician.
- Do not drop whichever predictor has the largest p value. That choice is made by chance variation in the sample, and a different sample would drop a different one.
Centring
Why do interaction terms give huge VIFs, and what does centring change?
A product term is built from its components, so it correlates with them. Subtracting a central value from the continuous variable before multiplying removes most of that correlation.
- What changes: the main-effect coefficients. With raw BMI the sedentary coefficient is the difference at BMI 0 (−2.16, p = 0.050). Centred, it is the difference at BMI 27 (0.85, p < 0.001).
- What does not change: the interaction coefficient, its p value, R² and the predictions. Iacobucci and colleagues (2017): centring before forming the product term “can clarify the regression coefficients” while the overall model fit R² remains undisturbed.
- What centring cannot fix: two different predictors that measure the same thing. Subtracting a constant does not change the correlation between weight and BMI.
Confounding, mediation, collinearity
Is the overlapping predictor a confounder, a mediator, or just a similar measure?
The same correlation between two predictors can have three different meanings. Each needs a different decision, and the data alone cannot tell them apart.
| Confounding | Mediation | Collinearity | |
|---|---|---|---|
| What it is | A third factor causes both exposure and outcome | The exposure acts through the third factor | Predictors in the sample overlap |
| Kind of problem | Bias | Wrong question if adjusted | Imprecision |
| If you adjust | Removes the bias from that factor | Estimates only the part of the effect not through it | Wider CIs and unstable coefficients |
| Decide from | Clinical knowledge of causes | Clinical knowledge of the pathway | Correlations, VIF |
| Example | Age, for BP drugs and stroke | Insulin resistance, for BMI and HbA1c | Weight and BMI, for SBP |
Schisterman, Cole and Platt (2009) define overadjustment bias as “control for an intermediate variable (or a descending proxy for an intermediate variable) on a causal path from exposure to outcome.” A confounder is often correlated with the exposure, so a well-chosen confounder can raise the VIF of the exposure. The wider confidence interval that results is reported, not removed by dropping the confounder.
Variable selection
How should you choose which predictors go into the model?
Choose them before the analysis, from the study question and what is known about the causes of the outcome. Automatic selection by p value gives models that look better than they are.
Start from background knowledge
Heinze, Wallisch and Dunkler (2018): “Modeling should start with defendable assumptions on the roles of IVs that can be based on background knowledge”, from previous studies, expert knowledge or common sense. Write the list of predictors, with the reason for each, in the protocol.
What stepwise methods do
- Forward selection: the predictor with the smallest p value enters first, then the next, while each p value is below the entry level.
- Backward elimination: all predictors enter, then the weakest is removed one at a time while its p value is above the removal level.
- Stepwise: forward selection that also re-checks and removes predictors already entered.
Why stepwise selection misleads
- The p values are wrong. The IBM SPSS documentation states: “The significance values in your output are based on fitting a single model. Therefore, the significance values are generally invalid when a stepwise method (stepwise, forward, or backward) is used.”
- It selects noise. In the simulation below, 645 of 1,000 studies with no real predictor selected at least one.
- The model is unstable and its coefficients are biased. Heinze and colleagues: variable selection “can compromise stability of a final model, unbiasedness of regression coefficients, and validity of p-values or confidence intervals.”
- It overfits. Babyak (2004) lists automated variable selection, pretesting of candidate predictors and dichotomization of continuous variables as practices that “pose a considerable risk for spurious findings in models.”
- It chooses between collinear predictors by chance. Of two predictors that measure one thing, whichever has the slightly smaller p value in this sample stays.
If you must select: Heinze and colleagues note that most statisticians prefer backward elimination over forward selection, “especially when collinearity is present”. Keep predictors that are needed on clinical grounds whatever their p value, report the method and its thresholds, and label the result exploratory.
Interactive
Run forward selection on pure noise and watch which predictors it picks
Try this: press "New study" several times. Many studies of pure noise still select at least one "significant" marker. Then press "Run 100 studies" and compare the R² in the study with the R² in new patients.
Simulation: 40 patients, 20 candidate laboratory markers, and an outcome that none of the markers affects. Forward selection enters the marker with the smallest p value while that p value is below the entry level.
Study 30: forward selection kept 2 markers, and the software prints them as if they had been planned.
| Selected marker | B | 95% CI | p |
|---|---|---|---|
| Marker 1 | -0.48 | -0.72 to -0.24 | < 0.001 |
| Marker 7 | 0.31 | 0.09 to 0.52 | 0.007 |
Overfitting
How many predictors can your data support?
Every predictor term uses up information. With too many terms for the number of patients (or events), the model describes chance features of this sample and predicts new patients badly.
- Count parameters, not variables. A factor with five categories uses four terms, an interaction one more, and a squared term one more. Riley and colleagues (2019) state sample size in “predictor parameters”.
- Linear regression: Austin and Steyerberg (2015) found that about two subjects per variable gave accurate coefficients, standard errors and confidence intervals, but that a much higher number was needed to estimate R² without bias. Adjusted R² behaved well.
- Logistic regression: Peduzzi and colleagues (1996) found biased coefficients with fewer than 10 events per variable. Vittinghoff and McCulloch (2007) found situations in which fewer were acceptable, and van Smeden and colleagues (2016) concluded: “The current evidence supporting EPV rules for binary logistic regression is weak.”
- Prediction models: Riley and colleagues (2019) replaced rules of thumb with criteria: a global shrinkage factor of 0.9 or more, a difference of 0.05 or less between apparent and adjusted R², and precise estimates of the residual SD and the mean. In their example, 25 predictor parameters needed at least 918 subjects, 36.7 per parameter.
- Parsimony: use the fewest terms that answer the question. A smaller prespecified model is easier to interpret and more likely to hold in new patients.
Model form
How do you choose the form of the regression?
Decide the form from the type of outcome, clinical knowledge and the residual plots, and write it in the protocol.
- Outcome type decides the family: linear for a measurement, logistic for yes/no, Cox for time to an event, Poisson for counts.
- Each continuous predictor: a straight line if the residuals show no curve. Otherwise a transformation (such as the logarithm), a squared term, or a spline.
- Keep continuous predictors continuous. Babyak (2004) includes dichotomization of continuous variables among the practices that risk spurious findings.
- Interactions only where there is a prior reason, planned in advance, with continuous components centred.
- Do not try many forms and keep the one with the smallest p value or the highest R². That is selection on the same data, with the same problems as stepwise methods.
Residual plots are explained, with an interactive element, in the multiple regression chapter.
Decide
A predictor has a high VIF: what should you do?
Answer the questions in order. Each answer links to the section that explains it.
What is the model for?
High VIF: all possible answers
- Leave the model as it is: Collinearity among adjustment variables does not inflate the standard error of the exposure. Check that the exposure itself has a low VIF.
- Centre the continuous variables: Subtract a sensible value before forming the product or square. The interaction coefficient, its p value and R² do not change; the main-effect coefficients become readable.
- Choose one measure, or combine them: Decide from the clinical question, before looking at p values, which measure to keep, or build one score from them. Report what you did.
- Keep the confounder and accept a wider interval: Removing a real confounder to lower the VIF gives a biased estimate. Report the VIF, the wider confidence interval, and consider a larger sample.
- Do not adjust for the mediator: Adjusting for a variable on the causal path removes part of the effect you want to estimate (overadjustment). Leave it out for the total effect.
- The individual coefficients matter less: Collinearity makes single coefficients unstable, but predictions for patients with the same pattern of predictors are affected little. Validate the model on new patients.
Comparison
Pairs that residents confuse
| Feature | Prespecified model | Stepwise selection |
|---|---|---|
| Predictors chosen by | The study question and clinical knowledge, before analysis | p values in the same data |
| p values and CIs | Valid for the planned model | Generally invalid (IBM SPSS documentation) |
| Collinear predictors | You decide which to keep, and why | Chosen by chance differences in p values |
| In new patients | Performs as the checks suggest | Usually performs worse than in the study |
| Report as | Confirmatory | Exploratory, with the method and thresholds |
| Feature | Collinearity | Confounding |
|---|---|---|
| Question it raises | Can the data separate these predictors? | Is the exposure estimate biased? |
| Detected by | Correlations, VIF, condition index | Clinical knowledge of causes, not a statistic |
| Effect on the exposure estimate | Wider CI, unstable value | Wrong value if the confounder is left out |
| Fix | Choose, combine, centre, more data | Adjust for the confounder, whatever its VIF |
The formula
Worked example: VIF, tolerance and condition number
Teaching data, made up: systolic BP in 50 adults on age, weight, BMI and waist. Every number was computed with statsmodels in Python.
- Regress BMI on the other predictors (age, weight, waist), ignoring SBP: R²BMI = 0.963.
- VIF = 1 ÷ (1 − 0.963) = 26.8 (26.80 from the unrounded R²). Tolerance = 1 ÷ 26.8 = 0.037.
- √26.8 = 5.18: collinearity alone makes the SE of the BMI coefficient about 5 times larger. Observed: SE 1.85 in the full model against 0.36 with age and BMI only, a ratio of 5.16.
- The other VIFs: age 1.02, weight 5.31, waist 18.34.
- Eigenvalues of the correlation matrix of the four predictors: 2.804, 1.000, 0.173, 0.023. Condition number = √(2.804 ÷ 0.0226) = 11.1.
- Body-size block: F(3, 45) = 12.33, p < 0.001, although no body-size coefficient has p < 0.05.
| Model (all include age) | Body-size coefficient (95% CI) | SE | Largest VIF | Adjusted R² |
|---|---|---|---|---|
| Weight + BMI + waist | BMI 2.07 (−1.66 to 5.81), p = 0.27 | 1.85 | 26.8 | 0.532 |
| BMI only | BMI 2.11 (1.39 to 2.83), p < 0.001 | 0.36 | 1.00 | 0.529 |
| Score: mean z-score of weight, BMI, waist | 9.63 per SD of score (6.12 to 13.14), p < 0.001 | 1.74 | 0.505 |
import statsmodels.api as sm from statsmodels.stats.outliers_influence import variance_inflation_factor X = sm.add_constant(d[["age", "weight", "bmi", "waist"]]) vif = [variance_inflation_factor(X.values, i) for i in range(1, X.shape[1])] print(vif) # 1.02, 5.31, 26.80, 18.34
In a real paper
Collinearity checks and variable selection in published studies
von Arnim CAF, Sadlonova M, Derad C, Hohberg M, Celano CM, Günther I, et al. Plasma amyloid-β 1-40 and postoperative delirium after cardiac surgery. JAMA Netw Open. 2026;9(7):e2625730.
doi:10.1001/jamanetworkopen.2026.25730 · PMID 42518233 · Free full text (PMC13416913)
The study: A prospective cohort of 491 patients aged 50 or older having elective cardiac surgery in Germany. Four plasma Alzheimer disease biomarkers were entered together, with clinical covariates, in a multiple linear regression for baseline cognition (MoCA) and in logistic regressions for postoperative delirium, so the authors checked the models with variance inflation factors.
“The model demonstrated the best overall fit (AIC, 435; BIC, 497) and discrimination ability (AUC, 0.77; 95% CI: 0.72-0.82; P < .001), with variance inflation factors of 1.1 to 5.5, indicating no problematic multicollinearity (eTable 5 in Supplement 1).”
The final delirium model discriminated best (area under the ROC curve 0.77). Its VIFs ranged from 1.1 to 5.5, and the authors read this as no problematic multicollinearity. In their methods they had defined a VIF above 5 as moderate multicollinearity, so the highest VIFs are above their own cut-off.
| Reported | Value | What it means |
|---|---|---|
| Cut-offs in the methods | >5 moderate, >10 substantial | The thresholds the authors set before the results |
| VIF range, final delirium model | 1.1 to 5.5 | The largest VIF is just above their moderate cut-off |
| Aβ1-40, simple linear regression on MoCA | −0.77 (−1.1 to −0.46) | Alone, a clear association with lower cognition, P <.001 |
| Aβ1-40, multiple linear regression on MoCA | −0.27 (−0.97 to 0.44) | With the other biomarkers, a smaller estimate with a much wider CI crossing 0, P = .45 |
| VIF for Aβ1-40 in that model | 5.7 | Its SE is about √5.7 = 2.4 times what it would be with no overlap |
| Patients with delirium | 106 (21.6%) | The events that limit how many predictors the logistic models can support |
- Compare the VIFs in the tables with the authors’ own threshold of 5, and look at which biomarkers carry the high values.
- Read the Aβ1-40 row in Table 2: the estimate becomes smaller and the CI wider when the other biomarkers are added. That is what collinearity does.
- Count the predictor parameters in each logistic model against the 106 delirium events. The analyses used complete case data, so the events available to each model may be fewer.
- Table 2 reports a linear model, yet its footnote says VIFs were calculated in the multiple logistic regression. Check which model each VIF belongs to.
van der Linden IA, Roodenburg R, Nijhof SL, van der Ent CK, Venekamp RP, van der Laan SEI, et al. Early-life risk factors for carotid intima-media thickness and carotid stiffness in adolescence. JAMA Netw Open. 2024;7(9):e2434699.
doi:10.1001/jamanetworkopen.2024.34699 · PMID 39302677 · Free full text (PMC11415786)
The study: A Dutch birth cohort (WHISTLER) study of 232 adolescents. Many early-life factors were candidates for explaining carotid intima-media thickness and stiffness, and the authors chose among them with stepwise multivariable linear regression after multiple imputation.
“At each step, variables were added based on P values, and a P value threshold of .10 was used to set a limit on the total number of variables included in the final model.”
Predictors were chosen by their P values in the same data, with .10 as the threshold. The final model is therefore the product of a selection process, and its P values and CIs are more optimistic than they would be for a planned model. The authors also chose the final model by the highest adjusted R², a second criterion.
| Reported | Value | What it means |
|---|---|---|
| Selection threshold | .10 | P value limit for keeping variables in the model |
| VIF range | 1.13 to 2.16 | Little overlap among the selected predictors |
| Adjusted R², intima-media thickness model | 0.11 | The selected predictors explain about 11% of the variation |
| Adjusted R², distensibility model | 0.13 | About 13% |
| Adolescents | 232 | The sample from which the predictors were selected |
- The methods describe "stepwise backward removal", yet this sentence says variables were added at each step. Check which procedure was used.
- Two stopping rules (P < .10 and the highest adjusted R²) can select different models. Ask which one decided.
- The authors themselves note the possible overestimation of P values in the final model and reduced performance in a new sample.
- With adjusted R² of 0.11 and 0.13, most of the variation is unexplained. Look for external validation before using these factors to predict.
How to run it
Checking collinearity and selecting predictors in SPSS, R and jamovi
Ask for the collinearity statistics every time you fit a multiple regression, and compare nested models with an F test rather than with automatic selection.
IBM SPSS Statistics
- Analyze > Regression > Linear..., with the dependent and independent variables as usual.
- Statistics: tick Collinearity diagnostics. SPSS then shows variance inflation factors and tolerances for each variable, with the eigenvalues of the scaled and uncentered cross-products matrix, condition indices and variance-decomposition proportions.
- To test a group of overlapping predictors, put them in a second block (Next) and tick R squared change.
- Method: Enter fits the planned model. Stepwise, Remove, Backward and Forward are selection methods. IBM states that significance values are generally invalid after stepwise, forward or backward selection.
- If a selection method is used, Options sets the Stepping Method Criteria: with Use Probability of F, a variable enters if its significance is below the Entry value and is removed if it is above the Removal value. The default tolerance is 0.0001.
R
fit <- lm(sbp ~ age + weight + bmi + waist, data = d) car::vif(fit) # VIFs, and generalized VIFs for terms with more than 1 df (package car) performance::check_collinearity(fit) # VIF and tolerance with confidence intervals (package performance) fit_bmi <- lm(sbp ~ age + bmi, data = d) anova(fit_bmi, fit) # F test: do weight and waist add anything once BMI is in? d$bmi_c <- d$bmi - 27 # centre before forming a product term step(fit, direction = "backward") # selection by AIC: report the result as exploratory
jamovi
- Analyses → Regression → Linear Regression, with the dependent variable and covariates as usual.
- Assumption Checks: tick Collinearity statistics for the VIF and tolerance of each predictor.
- Model Builder: put the overlapping predictors in a second block with “+ Add New Block”. jamovi then shows a Model Comparisons table for the blocks.
How to report it
What to write about collinearity and model building
Say how the predictors were chosen and why, how many parameters the model had for the sample size, how collinearity was checked and what was found, and what you did about it.
- Methods: the list of predictors and the reason for each, decided before analysis. How continuous predictors were modelled, and any planned interactions and centring. The collinearity checks (VIF, with the threshold). If any selection was done, the method and its entry and removal criteria.
- Results: the largest VIF, the predictors involved, and any change made. For selected models, the candidate list and the final model, labelled exploratory.
Age and BMI were chosen before analysis as predictors of systolic BP. Weight and waist circumference were not entered because they measure body size, as BMI does (correlation with BMI 0.89 and 0.97). No variance inflation factor exceeded 1.01. Systolic BP was 2.11 mmHg higher per kg/m² of BMI (95% CI 1.39 to 2.83, p < 0.001) and 0.71 mmHg higher per year of age (0.40 to 1.02, p < 0.001), with R² = 0.548.
If a selection procedure was used, add: the candidate predictors, the method (for example backward elimination), the removal p value, which predictors were kept regardless, and that the p values of the final model do not allow for the selection.
By specialty
Overlapping predictors by specialty
A model for eGFR decline enters serum creatinine, cystatin C and blood urea together.
These markers largely measure one thing, kidney function. Enter the one that answers the question, or one combination decided in advance.
Systolic BP, diastolic BP and pulse pressure are all entered as predictors of left ventricular mass.
Pulse pressure is systolic minus diastolic, so the three are exactly collinear. The software will drop one or refuse to fit. Choose two, or choose the pressure your question is about.
Length of stay is related to operating time, blood loss and units transfused.
Blood loss leads to transfusion, so transfusion is partly a step on the path. Decide whether you want the total effect of blood loss before adjusting for transfusion.
Age, ASA grade and the number of comorbidities are entered together to predict postoperative delirium.
They overlap. Check the VIFs, and keep the predictors your question needs, chosen before the analysis.
Gestational age and birth weight are both entered as predictors of neonatal hypoglycaemia.
Birth weight rises with gestational age. If the question is about growth for a given maturity, use a birth weight centile for gestational age instead of raw weight.
Pre-pregnancy BMI, gestational weight gain and gestational diabetes are entered together to explain birth weight.
Gestational diabetes may lie on the path from BMI to birth weight. Adjusting for it estimates only the part of the BMI effect that does not go through it.
Two depression rating scales scored on the same patients are both entered to predict functional recovery.
Both scales measure depression severity. Their coefficients will be unstable. Enter one scale, chosen before the analysis.
Income, education, occupation and a socioeconomic status score calculated from them are all in one model.
The score is a combination of the other three, so the model is almost exactly collinear. Use either the score or its components.
Common myths
Common mistaken beliefs
Myth: A high correlation between two predictors ruins the whole model.
It inflates the standard errors of the overlapping predictors only. In the teaching data, age had VIF 1.02 and almost the same SE with or without the three body-size measures (0.157 and 0.155).
Myth: A correlation matrix is enough to detect multicollinearity.
A predictor can be almost fully explained by two others without a high correlation with either. BMI correlated 0.06 with height, yet with all five predictors in the model its VIF was 234.
Myth: A predictor that is not significant has no effect and can be removed.
With collinear predictors, a large p value can mean the data cannot separate them. BMI had p = 0.27 in the full model and p < 0.001 once weight and waist were removed.
Myth: Stepwise selection finds the important predictors.
In 1,000 simulated studies with no real predictor, forward selection at p < 0.05 selected at least one in 645. IBM states that significance values are generally invalid after stepwise selection.
Myth: Ten events per variable is a proven rule.
Peduzzi and colleagues (1996) found problems below 10 events per variable in logistic regression. Later studies relaxed the rule (Vittinghoff and McCulloch, 2007) and judged the evidence for it weak (van Smeden and colleagues, 2016).
Myth: Centring removes multicollinearity.
Centring lowers the correlation between a variable and its product or squared term. It does not change the interaction coefficient or R², and it cannot separate two different measures of the same thing.
Why this matters to you
Five consequences of ignoring overlapping predictors
A result you cannot explain at the viva
A negative coefficient for weight that you report as "weight lowers blood pressure" when the data simply cannot separate weight from BMI.
A real effect reported as absent
BMI called "not significant" (p = 0.27) because weight and waist were entered with it, although it was clearly associated with SBP on its own and with age.
A thesis model that fails in new patients
Twenty candidate predictors and 40 patients, chosen by stepwise selection, give an impressive R² that disappears in the next sample.
A protocol that invites rejection
"All significant variables in univariate analysis will be entered into a stepwise model" gives no reasons, no list and no plan for overlapping predictors.
Misreading papers
Accepting a claim that a biomarker is "independent" when its VIF is above the authors’ own cut-off and its confidence interval crosses zero.
History
History of multicollinearity and model building
- 1934
Ragnar Frisch
Published Statistical Confluence Analysis by Means of Complete Regression Systems (Oslo). The term multicollinearity was first introduced in this work.
- 1970
Arthur Hoerl and Robert Kennard
Published “Ridge regression: biased estimation for nonorthogonal problems” in Technometrics.
- 1970
Donald Marquardt
Published “Generalized inverses, ridge regression, biased linear estimation, and nonlinear estimation”, the paper cited for the variance inflation factor and for the suggestion that a VIF should not exceed 10.
- 1996
Peter Peduzzi and colleagues
A simulation study found biased logistic regression coefficients with fewer than 10 events per predictor variable.
- 2004
Michael Babyak
Explained overfitting for clinicians, and showed that automated variable selection, pretesting of predictors and dichotomization of continuous variables risk spurious findings.
- 2007
Eric Vittinghoff and Charles McCulloch
Found situations in which fewer than 10 events per variable gave acceptable results, and concluded that the rule can be relaxed.
- 2016
Maarten van Smeden and colleagues
Concluded that the evidence supporting events-per-variable rules for binary logistic regression is weak.
- 2016
Dawn Iacobucci and colleagues
Showed that mean centring reduces the correlation between a product term and its components without changing the overall model fit.
- 2018
Georg Heinze, Christine Wallisch and Daniela Dunkler
Reviewed variable selection methods and recommended starting from background knowledge, with stability checks when selection is used.
- 2019
Jong Hae Kim
Summarised diagnosis of multicollinearity for clinicians: VIF above 5 to 10, condition indices above 10 to 30, and variance decomposition proportions.
Guidelines
Collinearity and model building in guidelines
“For multiple regression analyses: 1) report the alpha level used in the univariate analysis; 2) report whether the variables were assessed for a) colinearity and b) interaction; and 3) describe the variable selection process by which the final model was developed (e.g., forward-stepwise; best subset).”
On the choice of confounders: “we and others do not advise selecting confounders based solely on statistical significance testing”.
“Explain how the study size was arrived at (separately for development and evaluation), and justify that the study size was sufficient to answer the research question. Include details of any sample size calculation”.
Specify the type of model and “all model building steps, including any hyperparameter tuning, and method for internal validation”.
Reading a paper
Five checks on collinearity and model building in a paper
- Were the predictors chosen before the analysis for stated reasons, or by stepwise or univariate screening?
- Are VIFs (or another collinearity check) reported, with the threshold used, and do the authors act on values above it?
- Does any coefficient have the opposite sign to its unadjusted value, or a much wider CI than expected?
- Is the number of patients, or events, large for the number of predictor parameters, and was the model validated?
- Was a variable on the causal path adjusted for as if it were a confounder?
Why is it called that?
Word surgery
“Tolerance”
Willingness to put up with something.
1 − R² of one predictor regressed on the others: the share of that predictor left unexplained. Low tolerance means high overlap.
“Stepwise”
Careful, one step at a time.
An automatic procedure that adds or removes predictors by p value. It is not a careful method.
“Independent variable”
Free, unconnected.
A predictor. In a regression the predictors are often far from independent of one another.
The standard error is multiplied by √VIF: VIF 4 doubles it, VIF 9 triples it, VIF 16 quadruples it.
Collinear
everyday meaning: lying on the same straight line
Collinear predictors, plotted against each other, fall close to one line. Multicollinearity extends this to one predictor and a combination of several others.
Inflation
Latin inflatio: "a puffing up, a blowing into"
The variance inflation factor is how many times collinearity enlarges the variance of a coefficient.
Parsimony
Latin parsimonia: "sparingness, frugality, thrift"
A parsimonious model uses the fewest terms that answer the question.
Mediator
Latin mediare: "to be in the middle", from medius "middle"
A variable in the middle of the causal path from exposure to outcome. Adjusting for it removes part of the effect.
Confounding
Latin confundere: "to pour, mingle, or mix together"
The effect of a third factor is mixed in with the effect of the exposure.
Exam answers
Short-note outlines
Multicollinearity
- Definition: one predictor in a multiple regression is highly predictable from the others. Perfect collinearity: an exact linear combination.
- Mechanism: each coefficient is estimated from the part of its predictor not explained by the others. Little left over means an imprecise coefficient.
- Effects: inflated SEs, wide CIs, unstable coefficients that may change sign, a significant overall F with no significant t test. Overall fit and predictions are affected little.
- Detection: correlation matrix, VIF = 1 ÷ (1 − R²ⱼ) and tolerance (VIF above 5 to 10), condition index above 10 to 30, and variance decomposition proportions.
- Example (teaching data): SBP on age, weight, BMI and waist. VIF for BMI 26.8. BMI SE 1.85 against 0.36 without weight and waist.
- Management: check whether the exposure is affected, choose one measure or combine them, centre for product terms, keep true confounders, collect more data, or use ridge regression. Do not drop predictors by p value.
Variance inflation factor and tolerance
- Regress predictor j on all other predictors to get R²ⱼ. VIF = 1 ÷ (1 − R²ⱼ). Tolerance = 1 − R²ⱼ.
- VIF is the factor by which the variance of bⱼ is enlarged. √VIF enlarges the SE: VIF 4 doubles it.
- VIF = 1: no overlap. Values above 5 or 10 are the common cut-offs, which are rules of thumb.
- With two predictors, VIF = 1 ÷ (1 − r²): r = 0.9 gives 5.3, r = 0.95 gives 10.3.
- For a factor with several dummy variables, use the generalized VIF (car::vif in R).
- Centring lowers VIFs caused by product or squared terms without changing the interaction estimate.
Variable selection, stepwise regression and overfitting
- Preferred: choose predictors before analysis from background knowledge and the study question. Distinguish confounders (adjust) from mediators (do not adjust for a total effect).
- Stepwise methods: forward, backward, stepwise, by p value. Problems: invalid p values and CIs, selection of noise, biased and unstable coefficients, chance choice between collinear predictors.
- Overfitting: too many parameters for the data. The model fits chance features and predicts new patients badly. Count parameters, not variables.
- Sample size guidance: linear regression about 2 subjects per variable for coefficients (Austin and Steyerberg 2015). Logistic regression 10 events per variable (Peduzzi 1996), since relaxed and criticised. Prediction models: Riley criteria (2019).
- If selection is used: backward elimination, clinically required predictors forced in, method reported, result labelled exploratory, model validated.
- Reporting: SAMPL asks for collinearity, interaction and the variable selection process. TRIPOD+AI asks for the sample size justification and all model building steps.
The one thing to remember
When two predictors measure nearly the same thing, the data cannot say which one matters. Decide from the study question, before the analysis, which one belongs in the model.
The blood pressure data, the HbA1c interaction example and the simulations are made up for teaching. Every number was computed in Python (statsmodels 0.14, NumPy, SciPy 1.15) and checked against the calculations the interactive elements run in the browser.
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Further reading