Causation Concepts in Epidemiology

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Questions and Answers

Which criterion suggests that a stronger association is a better argument for causation?

Coherence

Experiment

Plausibility

Strength (correct)

What does the criterion of consistency refer to in the context of causal relationships?

Biological evidence supporting a hypothesis

Presence of a dose-response relationship

Repeated observations by different people across various contexts (correct)

Specific exposure linked to a particular outcome

What is meant by the specificity criterion in Hill's Criteria?

One cause leading to multiple effects

The relationship can be observed in similar diseases

Limited associations to a particular exposure and outcome (correct)

Evidence should be coherent with biological knowledge

Which criterion requires that the cause must precede the effect?

Temporality Signup and view all the answers

What does the biological gradient criterion imply about exposure and disease risk?

Increased exposure results in increased disease risk Signup and view all the answers

Which criterion emphasizes the need for the association to make sense within the biological context of the disease?

Coherence Signup and view all the answers

What kind of evidence does the experiment criterion suggest for supporting causation?

Experimental or semi-experimental evidence Signup and view all the answers

In Hill's Criteria, what does analogy refer to?

Applying known causal relationships to new situations Signup and view all the answers

What best describes direct causation?

A causes B without any intermediate effects. Signup and view all the answers

Which of the following is true regarding necessary causes?

The absence of a necessary cause means the effect cannot occur. Signup and view all the answers

What does the metaphor of the 'causal pie' illustrate?

Multiple component causes can lead to a disease. Signup and view all the answers

How is a sufficient cause defined in the context of disease causation?

A minimal set of conditions that can produce disease. Signup and view all the answers

Why may some diseases not have necessary causes, according to multiple causation theories?

There might be different sets of sufficient causes present. Signup and view all the answers

What is the role of causal inference in scientific literature on oral health?

To explore causal associations only after verifying true associations. Signup and view all the answers

Which statement correctly outlines the relationship between necessary and sufficient causes?

Some causes may be necessary but not sufficient. Signup and view all the answers

What does the component cause refer to in the causal pie model?

Any factor that contributes to completing a causal pie. Signup and view all the answers

Study Notes

Causation

Causation is defined as "anything producing an effect or a result"
Direct causation: A causes B without intermediate effects (rare)
Indirect causation: A causes B, but with intermediate effects
The cause or causative factor must precede the outcome in time

Nature of Cause

Rothman and Greenland (2005) developed the "multiple causation" concept
They used the "causal pie" metaphor, where disease occurs if a circle (pie) is completed by one or more component parts ("pies").
Each part is a cause for the disease.
This suggests a disease may occur due to a combination of factors in various situations.

Types of Causes

Necessary cause: Its presence is required for the disease to occur; it cannot occur in the absence of this cause.
Sufficient cause: A complete causal mechanism; a set of minimal conditions and events that inevitably produce disease.
Minimal conditions mean all conditions/events are necessary.
Each cause that contributes to the pie is a component cause.

Different Component Causes

Different component causes contribute to disease causation.
For some diseases, there may be no necessary causes, even with multiple sufficient causes.
Some causes are sufficient but not necessary, while others are necessary but not sufficient.

Causal Inference

Most associations in scientific oral health literature are interpreted as causal.
Potential causal associations should only be explored if the association is considered to be true.

Hill's Criteria

Useful for establishing epidemiological evidence of a causal relationship between a presumed cause and an effect
Strength: Stronger association, stronger argument for causation (large relative risk).
Consistency: Repeated observation of association across different persons, places, circumstances, and times
Specificity: Association limited to a particular exposure and outcome, with no association with other diseases (one cause, one outcome).
Temporality: Cause must precede the outcome.
Biological gradient: A dose-response curve showing an increase in exposure leading to increased disease risk. A stronger dose-response strengthens the causal argument.
Plausibility: Association should be biologically plausible (understandable in biological terms).
Coherence: Cause-and-effect interpretation shouldn't conflict with existing knowledge of the disease's natural history and biology.
Experiment: Experimental or semi-experimental evidence can support a causal link.
Analogy: Evidence from similar exposures or diseases can strengthen the analogy.

Epidemiologic Analysis

The use of comparisons is quantified by measures of association, like risk ratios, rate ratios, and odds ratios.

Risk

Risk is the probability of a disease or other health outcome occurring during a specified period.
Measures of risk include: absolute measures (incidence rate, attack rate, prevalence rate), relative risk (RR), and attributable risk percentage (AR).

Interpretation of Risk Measures

Relative Risk (RR): If RR = 1, risk of disease is the same in exposed vs unexposed groups. If RR > 1, exposure is a risk factor. If RR < 1, exposure is a protective factor.
Odds Ratio (OR): Another association measure, especially useful in case-control studies. If OR > 1, indicates a stronger association. If OR = 1, exposure and disease are unrelated. If OR < 1, indicates no association.

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Description

Explore the fundamental concepts of causation in epidemiology, including direct and indirect causation. Learn about necessary and sufficient causes, as well as the 'multiple causation' theory by Rothman and Greenland. This quiz will enhance your understanding of how various factors contribute to disease.