Epidemiology and Health

Methods

Equivalence model: A new graphical model for causal inference: Jalal Poorolajal; Epidemiol Health. 2020;42:e2020024. Published online April 9, 2020; DOI: https://doi.org/10.4178/epih.e2020024

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Abstract

Although several causal models relevant to epidemiology have been proposed, a key question that has remained unanswered is why some people at high-risk for a particular disease do not develop the disease while some people at low-risk do develop it. The equivalence model, proposed herein, addresses this dilemma. The equivalence model provides a graphical description of the overall effect of risk and protective factors at the individual level. Risk factors facilitate the occurrence of the outcome (the development of disease), whereas protective factors inhibit that occurrence. The equivalence model explains how the overall effect relates to the occurrence of the outcome. When a balance exists between risk and protective factors, neither can overcome the other; therefore, the outcome will not occur. Similarly, the outcome will not occur when the units of the risk factor(s) are less than or equal to the units of the protective factor(s). In contrast, the outcome will occur when the units of the risk factor(s) are greater than the units of the protective factor(s). This model can be used to describe, in simple terms, causal inferences in complex situations with multiple known and unknown risk and protective factors. It can also justify how people with a low level of exposure to one or more risk factor(s) may be affected by a certain disease while others with a higher level of exposure to the same risk factor(s) may remain unaffected.

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Citations

Citations to this article as recorded by

Risk of primary lung cancer after breast cancer radiotherapy: a systematic review and meta-analysis
Bushra Zareie, Mohammad Aziz Rasouli, Jalal Poorolajal
Breast Cancer.2022; 29(2): 361. CrossRef
The effect of silica exposure on the risk of lung cancer: A dose-response meta-analysis
Fatemeh Shahbazi, Mina Morsali, Jalal Poorolajal
Cancer Epidemiology.2021; 75: 102024. CrossRef
Factors for the Primary Prevention of Breast Cancer: A Meta-Analysis of Prospective Cohort Studies
Jalal Poorolajal, Fatemeh Heidarimoghis, Manoochehr Karami, Zahra Cheraghi, Fatemeh Gohari-Ensaf, Fatemeh Shahbazi, Bushra Zareie, Pegah Ameri, Fatemeh Sahraei
Journal of Research in Health Sciences.2021; 21(3): e00520. CrossRef
The Epidemiology of Aggression and Associated Factors among Iranian Adult Population: A National Survey
Jalal Poorolajal, Bahram Ebrahimi, Forouzan Rezapur-Shahkolai, Amin Doosti-Irani, Mahnaz Alizadeh, Jamal Ahmadpoor, Leila Moradi, Azam Biderafsh, Fateme Nikbakht, Zakie Golmohammadi, Ehsan Sarbazi, Samira Bahadivand, Marzieh Jahani Sayad Noveiri, Maryam R
Journal of Research in Health Sciences.2020; 20(4): e00499. CrossRef

Brief Communication

Evaluation report on the causal association between humidifier disinfectants and lung injury: Mina Ha, Soon Young Lee, Seung-sik Hwang, Hyesook Park, Seungsoo Sheen, Hae Kwan Cheong, Bo Youl Choi; Epidemiol Health. 2016;38:e2016037. Published online August 18, 2016; DOI: https://doi.org/10.4178/epih.e2016037

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Abstract

OBJECTIVES
As of November 2011, the Korean government recalled and banned humidifier disinfectants (HDs) from the market, because four case-control studies and one retrospective epidemiological study proved the association between HDs and lung injury of unknown cause. The report reviewed the causal role of HDs in lung injury based on scientific evidences.

METHODS

A careful examination on the association between the HDs and lung injury was based on the criteria of causality inference by Hill and the US Surgeon General Expert Committee.

RESULTS

We found that all the evidences on the causality fulfilled the criteria (strength of association, consistency, specificity, temporality, biologic gradient, plausibility, coherence, experiment, analogy, consideration of alternative explanations, and cessation of exposure), which proved the unknown cause lung injury reported in 2011 was caused by the HDs. In particular, there was no single reported case of lung injury since the ban in selling HDs in November 2011 as well as before the HDs were sold in markets.

CONCLUSIONS

Although only a few epidemiological studies in Korea have evaluated the association between lung injury and the use of HDs, those studies contributed to proving the strong association between the use of the HDs and lung injury, based on scientific evidence.

Summary

Korean summary
본 논문에서는 Hill의 기준과 US Surgeon General 전문위원회에서 제시하는 기준에 근거하여 가습기살균제와 폐손상과의 인과성을 검토하였다. 검토결과, 11개 조건(관련성의 강도, 일관성, 특이성, 시간적 선후관계, 생물학적 용량-반응 관계, 개연성, 기존 지식과의 일치성, 실험, 유사성, 다른 가능한 해석에 대한 고려 및 노출의 중단) 을 모두 충족함을 확인하므로 써, 2011년 발생한 원인미상 폐손상의 원인이 가습기살균제 노출로 인한 것임을 알 수 있었다. 무엇보다도 가습기살균제 시판 전에는 원인미상 폐손상이 보고된 바가 없었고, 2011년 11월 가습기살균제 판매중지 이후 폐손상이 한 건도 발생하지 않은 것은 원인미상의 폐손상이 가습기살균제로 인한 것임을 강력하게 지지하는 것으로 판단된다.

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Citations

Citations to this article as recorded by

New-Onset and Exacerbation of Lung Diseases after Short-Term Exposures to Humidifier Disinfectant during Hospitalization
Seula Lee, Kyunghee Han, Jeonggyo Yoon, Eun-Kyung Jo, Wonho Yang, Yoon-Hyeong Choi
Toxics.2022; 10(7): 371. CrossRef
Characterizing Subjects Exposed to Humidifier Disinfectants Using Computed-Tomography-Based Latent Traits: A Deep Learning Approach
Frank Li, Jiwoong Choi, Xuan Zhang, Prathish K. Rajaraman, Chang-Hyun Lee, Hongseok Ko, Kum-Ju Chae, Eun-Kee Park, Alejandro P. Comellas, Eric A. Hoffman, Ching-Long Lin
International Journal of Environmental Research and Public Health.2022; 19(19): 11894. CrossRef
Physical analysis reveals distinct responses of human bronchial epithelial cells to guanidine and isothiazolinone biocides
Tae Yoon Kwon, Jaeseong Jeong, Eunyoung Park, Youngbin Cho, Dongyoung Lim, Ung Hyun Ko, Jennifer H. Shin, Jinhee Choi
Toxicology and Applied Pharmacology.2021; 424: 115589. CrossRef
Need for individual-based evaluation to determine the association between humidifier disinfectants and health injuries
Hyeong-Cheol Kim, Hyunil Kim, Eun-Chan Mun, Yesung Lee, Soyoung Park
Annals of Occupational and Environmental Medicine.2021;[Epub] CrossRef
Strength of Association. Report 1. Graduations of Relative Risk
А. Котеров, A. Koterov, Л. Ушенкова, L. Ushenkova, Э. Зубенкова, E. Zubenkova, А. Вайнсон, A. Vaynson, М. Калинина, M. Kalinina, А. Бирюков, A. Biryukov
Medical Radiology and radiation safety.2019; : 5. CrossRef
Causal inference in environmental epidemiology
Sanghyuk Bae, Hwan-Cheol Kim, Byeongjin Ye, Won-Jun Choi, Young-Seoub Hong, Mina Ha
Environmental Health and Toxicology.2017; 32: e2017015. CrossRef

Methods

The causality between smoking and lung cancer among groups and individuals: addressing issues in tobacco litigation in South Korea: Young-Ho Khang; Epidemiol Health. 2015;37:e2015026. Published online May 31, 2015; DOI: https://doi.org/10.4178/epih/e2015026

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Abstract

This article discusses issues on the causality between smoking and lung cancer, which have been raised during the tobacco litigation in South Korea. It should be recognized that the explanatory ability of risk factor(s) for inter-individual variations in disease occurrence is different from the causal contribution of the risk factor(s) to disease occurrence. The affected subjects of the tobacco litigation in South Korea are lung cancer patients with a history of cigarette smoking. Thus, the attributable fraction of the exposed rather than the population attributable fraction should be used in the tobacco litigation regarding the causal contribution of smoking to lung cancer. Scientific evidence for the causal relationship between smoking and lung cancer is based on studies of individuals and groups, studies in animals and humans, studies that are observational or experimental, studies in laboratories and communities, and studies in both underdeveloped and developed countries. The scientific evidence collected is applicable to both groups and individuals. The probability of causation, which is calculated based on the attributable fraction for the association between smoking and lung cancer, could be utilized as evidence to prove causality in individuals.

Summary

Korean summary
이 글에서는 우리나라 담배소송 과정에서 제기된 흡연과 폐암의 인과성에 대하여 논하였다. 질병 발생의 개인 간 변이에 대한 위험 요인의 설명력과 질병발생에 미치는 위험요인의 인과적 기여도는 다르다는 점을 지적하였다. 개인에서의 흡연과 폐암의 인과성에 대한 정보로 인과확률이 활용될 수 있음을 강조하였다.

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Citations

Citations to this article as recorded by

Trends in the of epidemiological perspectives on the causality of occupational diseases
Jun-Pyo Myong, Hyeongsu Kim, Kunsei Lee, Soung Hoon Chang
Journal of the Korean Medical Association.2018; 61(8): 466. CrossRef
Tobacco and epidemiology in Korea: old tricks, new answers?
Alex Broadbent, Seung-sik Hwang
Journal of Epidemiology and Community Health.2016; 70(6): 527. CrossRef

Original Article

The Role of the Epidemiological Causality of the Association between Smoking and Lung Cancer.: Kyung Hwan Lee, Hyun Hee Kang; Korean J Epidemiol. 2005;27(2):28-37.

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Abstract PDF: Abstract
It is generally accepted that acknowledgment of the causality of the association between smoking and lung cancer plays a crucial role in imposing liability on tobacco manufacturers in tobacco-related cases. However, acknowledgment of the epidemiological causality of the association is merely a precondition to putting liability on tobacco manufacturers; it does not play a crucial role. Smokers smoke manufactured tobacco by their right to choose according to their self-decision; therefore, it is not reasonable to place all liability concerning lung cancer on tobacco manufacturers. This paper studies the dual structure of the causality of the association between tobacco manufacturing and smoking as well as smoking and lung cancer. It can be understood that tobacco manufacturers must be held liable for lung cancer caused by smoking when there was intentional concealment or insufficient provision of information on the harmfulness of tobacco and the addictiveness of nicotine. The epidemiological causality of the association is the minimum scientific and legal precondition to placing liability on tobacco manufacturers for lung cancer caused by smoking. However, striving for protection and promotion of national health by, for instance, promoting antismoking programs, the epidemiological causality of the association adequately plays a social role when viewed from a public health perspective.; Summary

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