Epi Disease Causation Dr.

Coching Different models of disease causation - The epidemiologic triangle - The epidemiologic lever - The wheel - The web - Statistical association The epidemiologic triangle - Host - Agent - Environment More applicable for communicable diseases HOST AGENT ENVIRONMENT The epidemiologic lever AGENT HOST ENVIRONMENT Disease occurrence is compared to the disturbance of the state of balance of a hypothetical lever The wheel - Biological B S - Social environment G - Physical environment - Genetic make-up P The web - The effects never depend on single isolated causes - Caused by chains of associations - There can be as many variables included other than agent, host, environment genetics, socio-cultural beliefs, politics, education, religion, absence of technology, etc. Sufficient cause and component cause - An assumption of a 1 is to 1 correspondence between the observed causes and effects (necessary and sufficient) - Sufficient cause a set of minimal conditions and events that inevitably produce disease - Sufficient cause restriction to the minimum of required component cause - Component cause/s of sufficient cause maybe multiple but are not sufficient in themselves Strength of a causal factor - Guidelines for assessing causal association (Henle-Kochs postulate) o The organism is always found with the disease o The organism is not found with any other disease o The organism, isolated from one who has the disease, and cultures through several generations, produce the disease (in experimental animals) -

Even when an infectious disease can not be transmitted to animals, the regular and exclusive presence of the organism proves a casual relationship (postulate 1 and 2) Statistical causation - Association vs causation Statistical association Causal Direct indirect non causal

Independent variables - bias - incorrect temporality - confounding - Non statistical association independent variables - Without statistical association between two variables mostly means absence of causation - Variables in the study of causation: o Independent vs dependent Independent = cause Dependent = effect o Confounding variable Is a variable which cause or prevent the outcome (dependent variable) of interest o Intermediate variable It occurs in the causal pathway from an independent variable to a dependent variable It is statistically associated with both dependent and independent variables Other concepts of causation - Necessary vs sufficient cause o Necessary cause when the factor must be present for the disease to occur o Sufficient cause a cause that inevitably initiates an effect - Risk factor vs risk indicator o Risk factor an attribute that increases the probability of occurrence of disease o Risk indicator or risk marker, is an attribute that is associated with an increased probability of occurrence of a disease, not necessarily a causal factor Evidence of causality - Experimental evidence may not always be feasible - Non-experimental evidence o Strength strength of association the stronger the association the more likely the causality o Consistency repeated observation of an association under different conditions and circumstances o Specificity a cause leads to a single effect, not to multiple effects o Temporality the cause precedes the effect

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Biological gradient increased exposure equals increased effect Plausibility findings are consistent with other knowledge Reversibility removal of cause lead to reduction of disease risk Study design power of the study Judging the evidence how many lines of evidence lead to the conclusion