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Causation
06 PUBH500 Lecture 6 Causality FINAL
26
Health Care
Graduate
12/12/2011

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Term
descriptive epidemiology
Definition
the study of the amount and distribution of disease within a population
Term
analytic epidemiology
Definition
the study of the determinants of disease or reasons for relatively high or low frequency in specific groups
Term
primary goal of analytic epidemiology
Definition
to quantify causal relationships between an exposure and a health or disease outcome.

determine the relationship between the exposure and the health outcome
Term
Fundamental Questions about exposures and health outcomes
Definition
Is there a causal relationship between this health outcome and this exposure?

if so then how strong is this relationship?

how much of this health outcome can be attributed to this exposure?
Term
how can we establish causality?
Definition
experimental study
or
observational study
Term
experimental study as used to establish causality
Definition
assign treatments or exposures randomly to participants
any observed difference in outcomes can be attributed to the treatment

remember: an experiment might not be feasible
Term
observational study as used to establish causality
Definition
includes a case control, cohort, cross-sectional study, etc.

establishing causality from observational data is the central challenge of analytic epidemiology
Term
causation: what is a cause?
Definition
a factor that produces an effect or makes a difference
Term
association vs causation
Definition
more often than not we are dependent upon our observation and enumeration of defined events for which we then seek antecedents. in other words we see that the event b is associated with the environmental feature a. in what circumstances can we pass from this observed association to a verdict of causation?
Term
bradford hill's criteria for assessing causation
Definition
strength of association

consistency

specificity

temporality

biological gradient

plausibility

coherence

experiment

analogy
Term
strength of association
Definition
large associations are more likely to be causal than small ones

more difficult to think of alternative explanations for large associations - ie more difficult to explain them away by systematic or random error

examples: percival pott's conclusions about chimney sweeps and scrotal cancer

smoking and lung cancer

john snow:relative death rates of cholera in houses supplied by different water companies.
Term
consistency
Definition
evidence for causality is stronger if the association is replicated in different populations, by different researchers at different times using different study designs.

single studies are rarely definitive.
Term
specificity
Definition
is there a one-to-one relationship between exposures and disease outcomes?

note, however, that some causes lead to many diseases like contaminated milk and some diseases have many causes, ie scrotal cancer
Term
temporality
Definition
exposure must precede disease
Term
biological gradient
Definition
strength of association increases as exposure level increases. example: death rate from cancer increases linearly with number of cigarettes smoked daily.

dose-response.
Term
plausibility
Definition
is there an existing biological or social model to explain the association?
Term
coherence
Definition
association consistent with generally known facts of the natural history and biology of disease

similar to plausibility
Term
experiment
Definition
experiment that modifies exposure through prevention, treatment or removal should result in less disease.

may be infeasible or unethical.
Term
analogy
Definition
association between exposure and disease has characteristics or features that are similar to other associations generally regarded as causal

examples: thalidomide and rubella in pregnancy.
Term
Internal validity of a study
Definition
can the study measure what it sets out to measure? is it free from systematic error (bias)?
Term
external validity
Definition
can results be extrapolated to other populations, settings, etc?
Term
sources of error
Definition
random error

systematic error (bias)
Term
random error
Definition
measurement results that differ from the true value due to chance
Term
systematic error (bias)
Definition
any systematic error in the design, conduct, or analysis of a a study that results in a mistaken estimate of an exposure's effect on the risk of disease.
Term
main categories of bias
Definition

selection bias: absence of comparability between groups being studied. the causal relation between exposure and disease is distorted due to (a) procedures used to select or exclude subjects, (b) differences between participants and nonparticipants, and (c) differences in follow-up or drop-out rates that differ according to a causal exposure. information bias: has the information been gathered in the same way? incorrect determination of exposure and/or outcome; if bias is differential by group this may increase or decrease the relative risk/odds ratio; if non-differential "noise in the system" the odds ratio may be shifted towards 1 (no association). some types of information bias: diagnostic suspsicion bias, surveillance bias, recall bias, reporting or wish bias, bias in abstracting records, bias in interviewing. confounding (bias) is an extraneous factor blurring the effect? the causal relation between exposure and disease is distorted due to association of the exposure with other factors that influence the outcome. the effect of the exposure is mixed together with the effect of another exposure, leading to bias. what is a confounder? if we want to know whether factor A is a cause of disease B, then a third factor X is a confounder if Factor X is a  known risk factor of disease B and Factor X is associated with Factor A, but is not a result of factor A. Some approaches to addressing confounding: during study design, restrict study to those without confounder or match on confounder; during data analysis, stratify by confounder or adjust for confounder in multivariate models. 

 

something "different" distorts the planned comparison.

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