Causal Inference in Cancer Epidemiology

2017 ◽  
Author(s):  
Steven N. Goodman ◽  
Jonathan M. Samet
Keyword(s):  
Risk Factors ◽  
Causal Inference ◽  
Cancer Epidemiology ◽  
Consistency Strength ◽  
Population Research ◽  
Surgeon General ◽  
Bradford Hill ◽  
The Us ◽  
Strength Of Association ◽  
Multiple Causes

Judgments about causality are central to the development of interventions intended to reduce exposure to risk factors that cause cancer. Because causation is not directly observable in medicine, scientists and philosophers have had to develop sets of constructs and heuristics that define “cause” operationally. The criteria in this framework, often attributed to the British medical statistician Sir Austin Bradford Hill or to the 1964 Report of the US Surgeon General on tobacco, include consistency, strength of association, specificity, temporality, coherence/plausibility/analogy, biological gradient, and experiment. This chapter reviews these criteria in depth and considers the challenges of applying them to population research on cancer. It discusses the concepts of causation in the context of the multistage nature of cancer, the “counterfactual” notion of causation, the component cause model for understanding diseases with multiple causes, and the “weight of the evidence” approach for integrating information from multiple lines of research.

The Great Influenza

2018 ◽  
Author(s):  
Samuel K. Cohn, Jr.
Keyword(s):  
Social Behaviour ◽  
East Coast ◽  
World History ◽  
Collective Violence ◽  
Large Cities ◽  
Surgeon General ◽  
The Us ◽  
History Of Disease ◽  
The World ◽  
History Of

This chapter examines evidence principally from the US that the Great Influenza provoked profiteering by landlords, undertakers, vendors of fruit, pharmacists, and doctors, but shows that such complaints were rare and confined mostly to large cities on the East Coast. It then investigates anti-social advice and repressive decrees on the part of municipalities, backed by advice from the US Surgeon General and prominent physicians attacking ‘spitters, coughers, and sneezers’, which included state and municipal ordinances against kissing and even ‘big talkers’. It then surveys legislation on compulsory and recommended mask wearing. Yet this chapter finds no protest or collective violence against the diseased victims or any other ‘others’ suspected of disseminating the virus. Despite physicians’ and lawmakers’ encouragement of anti-social behaviour, mass volunteerism and abnegation instead unfolded to an extent never before witnessed in the world history of disease.

scholarly journals THU0442 GOUT AND HEART FAILURE IN THE US: A NATIONAL PERSPECTIVE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 458.2-458
Author(s):  
G. Singh ◽  
M. Sehgal ◽  
A. Mithal
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Confidence Intervals ◽  
Burden Of Illness ◽  
Average Length ◽  
Private Insurance ◽  
Significant Risk ◽  
Case Fatality ◽  
The United States ◽  
The Us

Background:Heart failure (HF) is the eighth leading cause of death in the US, with a 38% increase in the number of deaths due to HF from 2011 to 2017 (1). Gout and hyperuricemia have previously been recognized as significant risk factors for heart failure (2), but there is little nationwide data on the clinical and economic consequences of these comorbidities.Objectives:To study heart failure hospitalizations in patients with gout in the United States (US) and estimate their clinical and economic impact.Methods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in the NIS in 2017, the most recent year of available data, with a primary or secondary diagnosis of gout and heart failure. Over 69,800 ICD 10 diagnoses were collapsed into a smaller number of clinically meaningful categories, consistent with the CDC Clinical Classification Software.Results:There were 35.8 million all-cause hospitalizations in patients in the US in 2017. Of these, 351,735 hospitalizations occurred for acute and/or chronic heart failure in patients with gout. These patients had a mean age of 73.3 years (95% confidence intervals 73.1 – 73.5 years) and were more likely to be male (63.4%). The average length of hospitalization was 6.1 days (95% confidence intervals 6.0 to 6.2 days) with a case fatality rate of 3.5% (95% confidence intervals 3.4% – 3.7%). The average cost of each hospitalization was $63,992 (95% confidence intervals $61,908 - $66,075), with a total annual national cost estimate of $22.8 billion (95% confidence intervals $21.7 billion - $24.0 billion).Conclusion:While gout and hyperuricemia have long been recognized as potential risk factors for heart failure, the aging of the US population is projected to significantly increase the burden of illness and costs of care of these comorbidities (1). This calls for an increased awareness and management of serious co-morbid conditions in patients with gout.References:[1]Sidney, S., Go, A. S., Jaffe, M. G., Solomon, M. D., Ambrosy, A. P., & Rana, J. S. (2019). Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017. JAMA Cardiology. doi:10.1001/jamacardio.2019.4187[2]Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open 2012;2:e000282.doi:10.1136/bmjopen-2011-000282Disclosure of Interests: :Gurkirpal Singh Grant/research support from: Horizon Therapeutics, Maanek Sehgal: None declared, Alka Mithal: None declared

Infant Sleep Position and Sudden Infant Death Syndrome Risk: A Time For Change

PEDIATRICS ◽  
1994 ◽  
Vol 94 (1) ◽  
pp. 105-107
Author(s):  
Carl E. Hunt
Keyword(s):  
Risk Factors ◽  
Sudden Infant Death ◽  
Sleep Position ◽  
Sudden Infant ◽  
Infant Sleep ◽  
Public Intervention ◽  
Infant Sleep Position ◽  
The Us ◽  
Epidemiological Risk ◽  
Health Objectives

I fully support a comprehensive professional and public intervention campaign in the US to establish supine as the standard sleep position. Although other preventive health objectives can be included, the emphasis needs to be clearly focused on sleep position. Achieving the lowest possible prone prevalence rate in the US is thus the first goal of this new campaign. The second and equally important goal of the new campaign should be to utilize this opportunity to maximum advantage to enhance our knowledge regarding the epidemiological risk factors causally related to SIDS and their interactions, and the interactions between epidemiological and biological risk factors. In addition to quantifying changes in infant mortality and in infant sleep position, we will also need to characterize both the supine and the persistent prone infant groups in regard to all of the putative epidemiological risk factors for SIDS. This campaign can thus enhance our understanding of the epidemiological risk factors for SIDS as long as a significant decrease in prone prevalence can be achieved.

scholarly journals Reproductive risk factors and breast cancer: a case control study from rural India

2015 ◽  
Vol 14 (3) ◽  
pp. 258-264 ◽  
Author(s):  
Vaishali R Mohite ◽  
Asha K Pratinidhi ◽  
Rajsinh Vishwasrao Mohite
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Breast Feeding ◽  
Menopausal Status ◽  
Hormonal Contraceptives ◽  
Reproductive Risk ◽  
History Of ◽  
Reproductive Risk Factors ◽  
Post Menopausal ◽  
Strength Of Association

Background: Breast cancer is the most common type of cancer in women and is influenced by reproductive factors perceived by women worldwide.Aims: To identify the reproductive risk factors of breast cancer in newly diagnosed cases and to find out the strength of association of the risk factors with the breast cancer. Material and Methods: A hospital based case-control study was conducted in Satara district, India during year 2009 to 2011 among newly diagnosed cases of breast cancer and matched controls. A total of 434 participants including 217 cases and 217 controls were enrolled by purposive sampling technique from selected hospitals of study area. The information was collected by employing pre-tested questionnaire by utilizing interview method. Statistical Analysis used: Descriptive statistics, Odds ratio and Chi-square test was used to find out strength of association and statistical significant difference. Results: Highest proportion [31.80%] breast cancer cases was in age group 40-49 years with lowest age of 25 years at diagnosis of the disease. A very high proportion of both cases [88.02%] and controls [67.28%] were Hindu by religion and were from rural residence. Maximum proportion of breast cancer cases were housewives [63.59%], literate [71.42%] and from upper economic class [56.68%]. The proportions of cases were higher as compared to the controls with respect to risk factors like unmarried status, nulliparity, history of abortion, post menopausal status, absence of breast feeding and the history of exposure to hormonal contraceptives. The risk of getting breast cancer as indicated by Odds ratio was 8 times higher in unmarried women, 2.8 times in nulliparous women, 2.4 times with post menopausal status, 10.4 times with absence of breast feeding, 1.5 times with exposure to hormonal contraceptives and 4.5 times with history of ovarian disease respectively. Conclusion: The reproductive risk factors such as unmarried status of women, nulliparity, menopause, absence of breast feeding, history of ovarian disease and use of contraceptives were strongly associated with breast cancer.Bangladesh Journal of Medical Science Vol.14(3) 2015 p.258-264

scholarly journals Hepatitis B: diagnosis, prevention, and treatment

1997 ◽  
Vol 43 (8) ◽  
pp. 1500-1506 ◽  
Author(s):  
Norman Gitlin
Keyword(s):  
Risk Factors ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Chronic Infection ◽  
Laboratory Tests ◽  
Chronic Viral Hepatitis ◽  
Hbv Infection ◽  
B Virus ◽  
The Us ◽  
Prevention And Treatment

Abstract Hepatitis B virus (HBV) infection occurs worldwide and is an important cause of acute and chronic viral hepatitis in the US. In this review, I describe the virus, risk factors for infection, clinical features of infection, results of laboratory tests during infection, and standard and emerging treatment for chronic infection. Although 95% of adult patients recover completely from HBV infection, 90% of children ≤4 years of age develop chronic infection. Active vaccination is highly efficacious.

scholarly journals Vascular risk at younger ages most strongly associates with current and future brain volume

Neurology ◽  
2018 ◽  
Vol 91 (16) ◽  
pp. e1479-e1486 ◽  
Author(s):  
Matthew P. Pase ◽  
Kendra Davis-Plourde ◽  
Jayandra J. Himali ◽  
Claudia L. Satizabal ◽  
Hugo Aparicio ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Stroke Risk ◽  
Brain Volume ◽  
Vascular Risk Factor ◽  
Vascular Risk Factors ◽  
Vascular Risk ◽  
Cross Sectional ◽  
Strength Of Association ◽  
Risk Factor Burden

ObjectiveGiven the potential therapeutic effect of vascular disease control timing to reduce dementia risk, we investigated the age-related influences of vascular risk factor burden on brain structure throughout the lifespan.MethodsWe studied participants from the community-based prospective Framingham Heart Study. Overall vascular risk factor burden was calculated according to the Framingham Stroke Risk Profile, a validated algorithm that predicts stroke risk. Brain volume was estimated by MRI. We used cross-sectional data to examine how the strength of association between vascular risk factor burden and brain volume changed across each age decade from age 45–54 years through to 85–94 years (N = 2,887). Second, we leveraged up to 40 years of longitudinal data to determine how the strength of association between vascular risk factor burden and brain volume changed when vascular risk factors were examined at progressively earlier ages (N = 7,868).ResultsIn both cross-sectional and longitudinal analyses, higher vascular risk factor burden was associated with lower brain volume across each age decade. In the cross-sectional analysis, the strength of this association decreased with each decade of advancing age (p for trend < 0.0001). In longitudinal analysis, the strength of association between vascular risk factor burden and brain volume was stronger when vascular risk factors were measured at younger ages. For example, vascular risk factor burden was most strongly associated with lower brain volume in later life when vascular risk factors were measured at age 45 years.ConclusionVascular risk factors at younger ages appear to have detrimental effects on current and future brain volume.

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