宿主环境病因疾病disease.PPT

主要内容 (outline) 第一节 病因的概念 concepts of causation 统计关联到因果关联From Epidemiological Association to Causation The frequency or strength of an event or risk factor varies with the frequency of the disease or condition. Increased numbers of children not immunized against measles causes the incidence rate for measles to go up. 共变法（concomitant variations canon） 吸烟与肺癌；氟龋齿、斑釉齿 Subduct from any phenomenon such part as is known by previous inductions to be the effect of certain antecedents, and the residue of the phenomenon is the remaining antecedents. 剩余法（residues canon） 乙肝病毒＋黄曲霉毒素－肝癌（藻类毒素） 病例对照研究（case-control study） 队列研究（cohort study） 病因假设的检验和验证 （test and certification of hypothesis） 二、病因推断中暴露因素与疾病关联的解释Association between exposure and disease in causal inference 统计学关联 （statistics association） 虚假关联 （spurious association） 间接关联 （indirectassociation） Interpreting Associations- Causal and Non-Causal Causal Non-Causal (due to confounding) Characteristic Under Study Characteristic Under Study Disease Factor X Disease Interpreting Associations- Causal and Non-Causal Causal Non-Causal (due to confounding) Coffee Consumption Coffee Consumption Pancreatic Cancer Smoking Pancreatic Cancer Spurious Association Real Association Real Association 暴露与疾病 exposure and disease 有无统计学关联? statistical association 有无偏倚? bias 有时间先后否? temporal sequence 关联的强度 关联的重复性 关联的时间顺序 病因与疾病分布一致 终止效应 剂量反映关系 关联的特异性 关联的生物学合理性 第三节 病因推断标准 criteria of causal inference strength consistency temporality coherence reversibility dose-response relationship specificity biologic plausibility 因果推断标准(1)--关联的强度 关联强度越大，为因果的可能性越大 A strong association between possible cause and effect, is more likely to be causal than a weak association. 关联强度的测定 measurement of strength RR,OR criteria of causal inference 1--strength 因果推断标准(1)--关联的强度 criteria of causal inference 1--strength 不同人群、不同地区、不同时间、不同类型的研究 少数或个别研究不同甚或相反的结果并不能简单地反驳因果假设 多数得到一致结果的研究可能遭遇共同的偏倚 研究间不同的结果可能是因为某些因素的修正作用 因果推断标准(2)－关联的重复性