病因原因不易定义形而上学causal inferenceen推理.pptx

Etiology

Cause“Cause”isnoteasilydefinedDefinitionsaremetaphysicalRothmanGreenland’s(1998)definition:anyevent,act,orconditionprecedingdiseasewithoutwhichdiseasewouldnothaveoccurredorwouldhaveoccurredatlatertime

Inepidemiologyacausecanbeconsideredtobesomethingthataltersthefrequencyofdisease,healthstatusorassociatedfactorsinapopulation.LilienfeldAM.（1920-1984）

Atthetime,itwasassumedthatcholerawasairborne.However,Snowdidnotacceptthismiasma(badair)theory,arguingthatinfactenteredthebodythroughthemouth.

InAugust1854,acholeraoutbreakoccurredinSoho.Aftercarefulinvestigation,includingplottingcasesofcholeraonamapofthearea,SnowwasabletoidentifyawaterpumpinBroad(nowBroadwick)Streetasthesourceofthedisease.

Hehadthehandleofthepumpremoved,andcasesofcholeraimmediatelybegantodiminish.However,Snowsgermtheoryofdiseasewasnotwidelyaccepteduntilthe1860s.

Sufficient/ComponentCause

Sufficient/ComponentCause(CausalPies)Anecessarycause-afactorfoundinallcasesContributingcause–anon-necessaryfactorthatisneededinsomecasesSufficiency–combinationoffactorsthatmakediseaseinevitable?completed“pie”(seenextslide)

CausalPiesNote:thereismorethanonesufficientmechanismforagivenailment

CausalComplementAcausalcomplementisafactororsetoffactorsthatcompleteasufficientcausalmechanism(pie)e.g.,ConsidertuberculosisTheagent(Mycobacteriasp.)isnecessary“Susceptibility”iscomplementary

Sufficient/ComponentCause(cont.)TheeffectofafactorinapopulationdependsonprevalenceofcausalcomplementsTheeffectofMycobacteriumexposureinafullyimmunepopulationisnil(increasesriskby0%)TheeffectofMycobacteriumexposureinafullysusceptiblepopulationis100%Wecannottalkaboutcauseinisolation

Causalinference

Henle-Koch’sPostulate（1882）Henle（1809-1885）