Causation

Understanding causation

Narrated by Prof Brendan Girdler-Brown

Introduction

In this video we will introduce the concept of causation and identify

And explain the epidemiological triad model of causation.
We will illustrate this model as applied to road traffic accidents.
In later videos we will learn about two alternative models of
causation as well.

Causation 2020/2023

What is a “cause”?

A cause of a disease or injury is an event, condition, characteristic,

or a combination of these factors, that plays an important role in
producing the health outcome (Bonita et al.)
A mere association does not “prove” causation:
Carrying a cigarette lighter is associated with lung cancer: but almost certainly does not
cause lung cancer

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 Epidemiological Elements

• Distribution by:
- Person, place & time

• Determinants:
- Biological determinants;
- Socio-cultural determinants;
- Economic determinants; and
- Other external/ environmental determinants

Causation 2020/2023

Why is causation important?

Determining the cause of a disease allows us to ……

Initiate appropriate prevention and promotion;

Enact legislation (policy implementation);
Adapt medical education;
Allocate resources appropriately in health care;
Develop essential nutritional and pharmacological interventions; and
Increase the evidence base for medical practice

Causation 2020/2023

Multi-causality
.
• For one disease there may be many causes;
• Any one cause may lead to more than one disease;
• Epi studies explore relationships between exposures and effects (i.e. diseases);
• Hypothesis of interest: is the exposure causally related to the effect/ outcome?;
• “EXPOSURE” and “OUTCOME” can take many forms:
E = cigarette smoking; O = lung cancer
E = health education; O = reduced smoking

Note that a causal Exposure must precede the Outcome (“temporality”)

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 Models of causation

Ø Epidemiological Triad approach/ model

We will illustrate the following models in the next video:

• Chain of Causation approach/ model

• Necessary, sufficient and component causes approach

Causation 2020/2023

Epidemiological Triad
The traditional “host; agent; and environment” model

Disease is the result of a complex interaction of

host, agent and environment factors.

The model is useful for targeting interventions

at the host, agent and environment and encourages
multifaceted control measures.

Causation 2020/2023

Epidemiological Triad Think of interventions:

Education? Laws? Policing?
As an applied example, let us consider road traffic accidents Vehicle design standards?
Road standards?
Environmental factors Licensing/ re-licencing?
Design of roads Testing/ re-testing?
Street lighting
Agent factors Road markings
Vehicle roadworthiness Potholes
Tyre condition Signage Host factors
Seat belts Weather Age
Airbags Training
Head rests/ neck supports Eyesight
Age/ weight appropriate Hearing
child booster seats Illnesses (e.g. epilepsy)
Overloading Medication
TRIAD Substance use

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 Thank You

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