Chapter 5 Concepts of Interaction – Reduced Content

By Genevieve M. Nangit

This is my reduced version of Chapter 5 of Modern Epidemiology 3rd edition by KJ Rothman, S

Greenland, T Lash. I leave the details such as examples and tables in the book. There are three
guide questions to facilitate a comprehensive understanding of the concept of interactions, and
referring to the book is highly advised.

Contents

Guide Question ........................................................................................................................... 2

1. Introduction .......................................................................................................................... 2
2. Statistical Interaction and Effect-Measure Modification ..................................................... 2
3. Biologic Interactions ............................................................................................................ 2
4. Public Health Interactions .................................................................................................... 3

Page 1 of 3
Guide Question

1. Differentiate the interactions under potential-outcome model and sufficient-component

model.
2. Define the concept of scale dependence, and describe its role in identifying interaction.
3. Explain the use of case-load reduction in public health interaction.

1. Introduction

This chapter presents definitions and distinctions of the different concepts of interaction –
statistical interaction, biologic interaction and public health interaction. While methods in
studying interactions like stratified analysis, and limitations of such methods are described in
Chapter 16.

The concept of interaction centers on the idea that the occurrence of the disease in the exposed
group when compared to the unexposed group may depend on the presence of one or more other
conditions. There are two main issues that complicate the understanding of interaction, namely,
scale dependence and ambiguity of the term “interaction”.

In this booklet, the ambiguity of the term “interaction” was briefly addressed, while the issue on
“scale dependence” was totally left in the book.

2. Statistical Interaction and Effect-Measure Modification

Statistical interaction is a concept that refers to associations, whether causal or not. It is also
scale-dependent. It is equivalent to effect-measure modification when no bias is present, that is,
the observed association validly estimates the causal effect of interest.

3. Biologic Interactions

There are two major approaches to the topic of biologic (causal) interaction: (1) potential-
outcome model approach, and (2) sufficient-component model approach.

Page 2 of 3
The first approach is based on the potential-outcome or counterfactual causal model described in
Chapter 4. It has a long history in pharmacology (at least back to the 1920s) and is sometimes
called the dependent-action definition of interaction. The interaction under this model occurs
when the effect of one factor depends on the person's status for the other factor. An equally apt
description is to say that each factor modifies the effect of the other. There are two kind of
interaction under this model – synergistic effect and antagonistic effect. Synergistic effect occurs
when both factors must be present for disease to occur, that is, each factor causes the disease if
and only if the other factor is present. Antagonistic effect occurs when each factor blocks the
effect of the other, that is, each factor causes the disease if and only if the other factor is absent.

The second approach is based on the sufficient-cause model described in Chapter 2. This implies
that the interaction among two or more component causes, acting as exposure in the same
sufficient cause. Recall that a component cause is identical to a causal risk factor, of which its
occurrence contributes to completion of a sufficient cause. Suppose that different causal
mechanisms have different sufficient causes of disease. Now, if two component causes act to
produce disease in the same sufficient cause, then cases of disease will arise for which these two
component causes share in the causal responsibility; and the absence of either of the components,
the cases would not occur. Under the sufficient-cause model, this co-participation in a sufficient
cause is defined as synergistic interaction (i.e., synergism). There is also a mechanism that
requires the absence of one factor and presence of the other to produce disease. These correspond
to a sufficient cause in which one component cause is absent and another component cause is
present. The failure of the disease to occur is due to the presence of two component causes
manifesting an antagonistic interaction (i.e., antagonism).

4. Public Health Interactions

The general concept of public health interactions correspond to a situation in which public health
costs or benefits from altering one factor must take into account the prevalence of other factors,
because the presence and extent of public health interactions can vary with the benefit measure.
The study of public health interaction differs in a distinct way because the choice of the measure
is dictated by the public health context, rather than by statistical convenience or biologic
assumptions.

Page 3 of 3