ASSOCIATION AND CAUSATION

ASSOCIATION

If two attributes say A and B are found to co-exit
more often than an ordinary chance.

It is useful to consider the concept of correlation.

Correlation indicates the degree of association
between two variables.
CAUSATION

If one of these attributes say A is the suspected
cause and the other say B is a disease then we
have a reason to suspect that A has caused B.


Types Of Association
1. Spurious association
2. Indirect association
3. Direct association
One-to-one causal association
Multifactorial causation
Spurious Association
This is an association which appears due to improper
comparison.

Observed association between a disease and
suspected factor may not be real.

E.g.; Neonatal mortality was observed to be more in the
newborns born in a hospital than those born at home.
This is likely to lead to a conclusion that home
delivery is better for the health of newborn.
However, this conclusion was not drawn in the
study because the proportion of high risk deliveries
was found to be higher in the hospital than in home.
Indirect Association
It is a statistical association between a characteristic
of interest and a disease due to the presence of
another factor i.e. common factor (confounding
variable).

E.g.: Neonatal mortality (A) was found to be associated
with maternal age above 30 years (B) and with birth
order 4 and above (c).
It was also shown that the attribute B and C were
associated with each other.
Direct Association
The association between the two attributes is
not through the third attributes.

When the study reveals it is not a spurious
association.

When the disease is present, the factor must
also be present.
Direct Association Is Classified Into
Two Types
One-to-one Casual Relationship:

The variables are stated to be casual related (AB) if a
change in A is followed by a change in B.

When the disease is present, the factor must also be
present.

A single factor or cause may lead to more than one
outcome.
Direct Association Is Classified Into
Two Types
Multifactorial causation:

Alternative causal factors each acting
independently.

E.g. In lung cancer more than one factor (e.g. air
pollution, smoking, heredity) can produce the
disease independently.
Six Guidelines For Judging Whether An
Association Is Causal
Temporal Association
Consistency Of The Association
Specificity Of The Association
Strength Of The Association
Coherence Of The Association
Biologic Plausibility Of The Association

Temporal association
The causal attribute must precede the disease or
unfavorable outcome.
Exposure to the factor must have occurred before the
disease developed.
Length of interval between exposure and disease very
important
If the disease develops in a period of time too soon after
exposure, the causal relationship is called into question.

Consistency Of The Association
Consistency is the occurrence of the association at some other
time and place repeatedly.

If a relationship is causal, the findings should be consistent
with other data.

If lung cancer incidence increased as cigarette use was on the
decline, we would have to be able to explain how this was
consistent with a causal relationship.

If there is no consistency it will weaken a causal interpretation.

The causal association between smoking and lung cancer due
to its consistency.
Specificity Of The Association
The weakest of the criteria (should probably be
eliminated)

Specific exposure is associated with only one disease.

This is used by tobacco companies to argue that
smoking is not causal in lung cancer.
Smoking is associated with many diseases.

Specificity implies a one to one relationship between
the cause and effect.
Strength Of The Association
Relationship between cause and outcome could be
strong or weak.

With increasing level of exposure to the risk factor an
increase in incidence of the disease is found.

There are statistical methods to quantify the strength
of association viz; calculation of relative risk,
attributable risk etc.
Coherence Of The Association
Causal significance of an association is its
unity with known facts that are thought to be
related.

E.g.: the rising consumption of tobacco in the
form of cigarettes and the rising incidence of
lung cancer are coherent.
Biologic Plausibility Of The
Association

The association must be consistent with the
other knowledge (viz mechanism of action,
evidence from animal experiments etc).

Sometimes the lack of plausibility may simply
be due to the lack of sufficient knowledge
about the pathogenesis of a disease.