CAUSAL INFERENCE

BIOSTATISTICS AND EPIDEMIOLOGY // FIRST SEMESTER // FINALS

o Difference between POPULATION VALUE of parameter

being investigated and the ESTIMATE VALUE based on
the different samples.
 Statistical dependence between two variables.
 Systematic Errors: Biases and Confounding
 Either positive or negative (association)
o Distortion in the estimation of the magnitude of
 Process of using statistical methods to characterize the association between E and D (over or under estimation).
association between variables.  Deviation from the truth
 Due to bias
 Selection
 Information
 The process of ascribing causal relationships to associations  Confounding
between variables.

 Selection Bias: non-representative sample

 Causal  Information Bias: inaccurate information collected from sample.
o Direct o Misclassification
o Indirect  Differential (non-random) and Non-differential
 Non-causal (random)
 Sources:
 Instrument
 Subjects
 A factor that plays an essential role in producing an outcome.  Observers

DIFFERENTIAL (NON-RANDOM) NON-DIFFERENTIAL (RANDOM)

ASSOCIATION
Identifiable relationship between
exposure and disease.
Occurs when rates of errors differ Occurs when errors are in similar
in the groups being compared. proportion in groups being
CAUSE compared.
Presence of mechanism that leads
from exposure to disease.

CAUSAL
Alteration in the frequency or
quality of one event is followed by
a change in the other.
NON-CAUSAL
Association is a result of the
relationship of both factor and
disease with a third variable.
 Mixing the effect of the exposure on the disease with that of a 3rd
factor.
 Confounder
o Associated with the exposure
o Risk factor of the disease
 Can lead to over/under estimation of the association.

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: several statistical tests may be
applied.

 Strength of association: the higher that risk ratio, the higher the
chance to be causal.
 Temporality: temporal relationship; exposure precedes diseases.
 Consistency: consistent findings across different variables.
 Theoretical Plausibility: does not contradict the natural history of the
disease.
 Coherence
 Specificity in the causes: exposure leads to a single effect
 Dose-response relationship: the more the dose is being increased,
it affects the outcome.
 Experimental evidence

 Step 1: Determine the validity of the association

o Rule out chance, bias, confounding as explanation of the
observed association.
 Step 2: Determine if observed association is causal
o Consider totality of evidence taken from a number of
sources.
o Bradford Hill’s Criteria

INTERNAL VALIDITY VS. EXTERNAL VALIDTY

INTERNAL
Validity within the study
Estimate of effect measure is
accurate
Not due to systematic error
EXTERNAL
Validity beyond the study
Estimate generalizable to bigger
population
Not due to random error

 To estimate the value of the parameter with the little error.

 Random Errors: Sampling errors; chance

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