Causal Inference

Our Lady of Fatima University

College of Medical Laboratory Science
Biostatistics and Epidemiology (BIOE 211)
Statistical association
• statistical dependence between two variables
• either positive or negative (association)
• process of using statistical methods to characterize the association
between variables.

Causal inference
• process of ascribing causal relationships to associations between
variables
Causal Inference
• Types of association
• causal
• direct
• indirect
• noncausal
What is a Cause?

•Factor that plays an essential role in

producing an outcome
Association vs. Cause

Association Cause
• Identifiable relationship • Presence of mechanism that
between exposure and disease leads from exposure to disease
Causal vs. Non-Causal

Causal Non-causal
• Alteration in the frequency or • Association is a result of the
quality of one event is followed relationship of both factor and
by a change in the other disease with a third variable
Causal Non-causal
• Coffee consumption • Coffee consumption

• Smoking

• Pancreatic Cancer
• Pancreatic Cancer
Causal Non-causal
• Activity level • Activity level

• Age

• Weight gain
• Weight gain
Direct vs Indirect

Direct Indirect

A A

B
C
Process of Causal Inference
• Step 1: Determine the validity of the association
• rule out chance, bias, confounding as explanation of the observed
association

• Step 2: Determine if observed association is causal

• consider totality of evidence taken from a number of sources
Causal Inference
• Internal Validity
• Validity within the study
• Estimate of effect measure is accurate
• Not due to systematic error

• External Validity
• Validity beyond the study
• Estimate generalizable to bigger population
• Not due to random error
Goal of Epidemiologic Studies
• to estimate the value of the parameter with little error

• Sources of errors:
• random errors: sampling errors
• difference between POPULATION VALUE of parameter being
investigated and the ESTIMATE VALUE based on the different
samples
• systematic errors: biases and confounding
Sources of errors
• Random errors: sampling errors; chance
• difference between POPULATION VALUE of parameter being
investigated and the ESTIMATE VALUE based on the different samples
• Systematic errors: distortion in the estimation of the magnitude of
association between E and D (over or under estimation)
• deviation from the truth
• due to bias
• selection
• information
• confounding
Bias
• Selection Bias: non-representative sample

• Information Bias: inaccurate information collected from sample

• Misclassification
• Differential (non-random) and Non-differential (random)
• sources:
• instrument
• subjects
• observers
Confounding
• Mixing the effect of the exposure on the disease with that of a 3rd
factor
• CONFOUNDER
• Associated with the exposure
• Risk factor of the disease

• Can lead to over / under estimation of the association

Methods to control confounding
• A. Design stage
• Randomization: aim is random distribution of confounders between study groups
• Restriction: restrict entry to study of individuals with confounding factor
• Matching: aim for equal distribution of confounders

• B. Analysis stage
• Stratified analysis: confounders are distributed evenly within each stratum
• Multivariate analysis:
Causal Inference
• Step 1: Determine the validity of the association
• Rule out chance, bias, and confounding as an explanation of the observed
association

• Step 2: Determine if observed association is causal

• Consider totality of evidence taken from a number of sources
• HILL’S CRITERIA
Bradford Hill’s criteria for Causal Inference
• Strength of association
• Temporality
• Consistency
• Theoretical plausibility
• Coherence
• Specificity in the causes
• Dose-response relationship
• Experimental evidence
• Analogy
Thank you…