Causal diagrams in systems epidemiology

Michael Joffe, Manoj Gambhir, Marc Chadeau-Hyam, Paolo Vineis

Research output: Contribution to journalArticleResearchpeer-review

64 Citations (Scopus)

Abstract

Methods of diagrammatic modelling have been greatly developed in the past two decades. Outside the context of infectious diseases, systematic use of diagrams in epidemiology has been mainly confined to the analysis of a single link: that between a disease outcome and its proximal determinant(s). Transmitted causes ( causes of causes ) tend not to be systematically analysed. The infectious disease epidemiology modelling tradition models the human population in its environment, typically with the exposure-health relationship and the determinants of exposure being considered at individual and group/ecological levels, respectively. Some properties of the resulting systems are quite general, and are seen in unrelated contexts such as biochemical pathways. Confining analysis to a single link misses the opportunity to discover such properties. The structure of a causal diagram is derived from knowledge about how the world works, as well as from statistical evidence. A single diagram can be used to characterise a whole research area, not just a single analysis - although this depends on the degree of consistency of the causal relationships between different populations - and can therefore be used to integrate multiple datasets. Additional advantages of system-wide models include: the use of instrumental variables - now emerging as an important technique in epidemiology in the context of mendelian randomisation, but under-used in the exploitation of natural experiments ; the explicit use of change models, which have advantages with respect to inferring causation; and in the detection and elucidation of feedback.
Original languageEnglish
Pages (from-to)1 - 18
Number of pages18
JournalEmerging Themes in Epidemiology
Volume9
Issue number1
DOIs
Publication statusPublished - 2012
Externally publishedYes

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