Estimating the potential impacts of intervention from observational data: methods for estimating causal attributable risk in a cross-sectional analysis of depressive symptoms in Latin America

• Published in: Journal of epidemiology and community health (1979) 2010-01, Vol.64 (1), p.16-21
• Main Authors: Fleischer, N L, Fernald, L C H, Hubbard, A E
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Biological and medical sciences; Causality; Cross-Sectional Studies; Depression; Depressive Disorder - epidemiology; Economic models; Epidemiologic Methods; Epidemiology; Expected values; General aspects; Humans; Intervention; Latin America; Medical sciences; Methods; Miscellaneous; Models, Statistical; Mood disorders; Observation; Observational studies; Population; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Researchers; Risk Factors; Social Support; Studies
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.2008.085985

Background:The field of epidemiology struggles both with enhancing causal inference in observational studies and providing useful information for policy makers and public health workers focusing on interventions. Population intervention models, analogous to population attributable fractions, estimate the causal impact of interventions in a population, and are one option for understanding the relative importance of various risk factors. With population intervention parameters, risk factors are effectively standardised, allowing one to compare their values directly and determine which potential intervention may have the greatest impact on the outcome.Methods:The difference between total effects and population intervention parameters was examined using naïve, G-computation and inverse probability of treatment weighting approaches. The differences between these parameters and the intuitions they provide were explored using data from a 2003 cross-sectional study in rural Mexico.Results:The assumptions, specific analytic steps, limitations and interpretations of the total effects and population intervention parameters are discussed, and code is provided in Stata.Conclusion:Population intervention parameters are a valuable and straightforward approach in epidemiological studies for making causal inference from the data while also supplying information that is relevant for researchers, public health practitioners and policy makers.