MORTALITY AND MARITAL-STATUS - REFLECTIONS ON DERIVATION OF ETIOLOGY FROM STATISTICS
MORTALITY AND MARITAL-STATUS - REFLECTIONS ON DERIVATION OF ETIOLOGY FROM STATISTICS
复制标题
DOI：
10.2105/ajph.52.8.1318
复制
发表时间：
1962-01-01
期刊：
影响因子：
--
通讯作者：
BERKSON, J
中科院分区：
文献类型：
--
作者：
BERKSON, J
在试图从统计相关性中找出环境因素在疾病起因中的病因学意义时，很容易陷入这样的做法：选择与看似合理的特定因素有关的特定疾病，而忽略相同疾病与其他因素的相似关联，以及相同因素与其他疾病的相似关联。这一趋势在最近被广泛报道的吸烟与肺癌死亡率之间的相关性中得到了明显的体现。发现的相关性是普遍的，涉及所有类别的疾病，不仅仅是肺癌。例如，有人争辩说，男性肺癌死亡率高于女性的原因是男性吸烟更多。然后，又有人争辩说，由于城市社区的吸烟率更高，或者因为空气污染，城市社区的肺癌死亡率比农村社区更高。但是，几乎所有同源癌症的男性死亡率都高于女性，几乎所有非癌症疾病的死亡率也是如此。在城市社区，其他癌症以及非癌症疾病的死亡率也更高。其他癌症既不能归因于吸烟也不能归因于空气污染。疾病死亡率的性别差异和城乡差异通常是最早发现的生命统计规律之一。它们已经被知道了300年--但在同样长的时间里还没有得到充分的解释。死亡率与婚姻状况相关的例子被用来说明这一谬误的其他方面。观察到的死亡率差异可能是由宪法决定的，而不是环境因素。环境导向理论谬误的可能含义具有革命性的重要意义，而宪法可以具有如此微妙的区分效果的建议本身就具有挑战性。那么，如果我们想知道是否整个情况可能不是由于统计数据中的系统性错误，我们也可以找到支持这一点的证据。
In seeking to find, from statistical correlations, etiologic significance of environmental factors in causation of disease, it is easy to fall into the practice of selecting particular diseases associated with particular factors that appear plausible, while ignoring similar associations of the same diseases with other factors, and of the same factors with other diseases. The tendency has been flagrantly exhibited in the recently much-publicized correlation between smoking and death rate from lung cancer. The correlations found are general and concern all classes of disease, not only lung cancer. It has been argued, for instance, that the greater death rate from lung cancer found among males than among females is attributable to the fact that men smoke more. Then again it is argued that the death rate from lung cancer is greater in urban than in rural communities because of the greater smoking rates characteristic of urban communities or because of air pollution. But the death rates from virtually all homologous cancers are greater among males than among females, and so are the rates from virtually all non-cancerous diseases. So also the death rate is greater in urban communities for other cancers - cancers that cannot be attributed to either smoking or air pollution - and for noncancerous diseases as well. The sex differential and the urban-rural differential of death rate from diseases generally are among the first laws of vital statistics discovered. They have been known for 300 years - and have not been adequately explained for the same length of time. The example of the association of death rate with marital status is used to illustrate other aspects of this fallacy. Observed differences of death rates may be determined constitutionally, rather than environmentally. The possible implication for the fallaciousness of environmentally oriented theories is of revolutionary import, while the suggestion that constitution can have such exquisitely differentiating effects is itself challenging. Then if we wonder whether the whole may not be due to systematic errors in the statistics, we can find support for this too.