Concepts and pitfalls in measuring and interpreting attributable fractions, prevented fractions, and causation probabilities

Abstract Measures of causal attribution and preventive potential appear deceptively simple to define, yet have many subtle variations and are subject to numerous pitfalls in conceptualization, interpretation, and application. This article reviews basic concepts, measures, and problems to serve as an...

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Bibliographic Details
Published in:Annals of epidemiology 2015-03, Vol.25 (3), p.155-161
Main Author: Greenland, Sander, MA, MS, DrPH
Format: Article
Language:English
Subjects:
Attributable fraction
Attributable risk
Causality
Causation
Data Interpretation, Statistical
Epidemiologic Methods
Etiologic fraction
Excess fraction
Humans
Internal Medicine
Models, Theoretical
Preventable fraction
Prevented fraction
Probability
Public health
Years of life lost
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Summary:Abstract Measures of causal attribution and preventive potential appear deceptively simple to define, yet have many subtle variations and are subject to numerous pitfalls in conceptualization, interpretation, and application. This article reviews basic concepts, measures, and problems to serve as an introduction to more detailed literature. Allowing for validity and generalization (projection) issues, epidemiologic attribution measures can serve as useful policy inputs for contrasting expected caseloads or survival times under different well-defined interventions. Nonetheless, their application in these settings requires attention to effects of the interventions besides those on the study outcome. Their use as estimates of etiologic attribution requires assumptions beyond the usual validity and statistical assumptions; these further assumptions will usually have little support or plausibility when the mechanisms of action are unknown.
ISSN:1047-2797
1873-2585
DOI:10.1016/j.annepidem.2014.11.005