Weighing the evidence: Bias and confounding in epidemiologic studies in allergy/immunology.
Weighing the evidence: Bias and confounding in epidemiologic studies in allergy/immunology.
复制标题
权衡证据：过敏/免疫学流行病学研究中的偏差和混杂因素。
DOI：
10.1016/j.jaci.2016.09.030
复制
发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Keet,CorinneA
中科院分区：
文献类型：
--
作者：
Matsui,ElizabethC;Keet,CorinneA
Although experimental study designs provide the strongest evidence for a causal relationship between a risk factor or treatment and a disease, epidemiologic studies contribute to the causal evidence base, and causality can be established with epidemiologic studies alone. For many questions related to whether an exposure causes a disease, such as the link between smoking and lung disease, it is simply not possible to conduct a randomized controlled trial because it is unethical or impractical. Examples of this type of question include questions related to the role of pollution, allergen, chemical, or microbial exposures in causing asthma. A set of criteria for assessing the strength of the evidence for causality was proposed by Bradford Hill in 1965 (Table I), 1 and critical public health findings established by epidemiologic studies include the relationship between smoking and lung cancer, sleep position and sudden infant death syndrome (SIDS), and air pollution and cardiovascular and respiratory disease. In addition, even when an epidemiologic study might not conclusively establish causality, such studies could suggest hypotheses, such as was the case with the association between earlier peanut introduction and reduced risk of peanut allergy. 2 With the broadening availability of large amounts of data from electronic medical records and other sources, observational studies offer the potential to efficiently study questions of major importance to allergy.Although a full discussion of epidemiologic methods, including study design, is beyond the scope of this article, we focus on some key pitfalls to consider when either designing or interpreting an epidemiologic study, and we will draw on examples from the allergy/immunology literature to illustrate these concepts (Table II). The focus of this article is on the fundamental concepts of epidemiology that are critical to assessing the validity of findings from epidemiologic studies. Those studies that emerge as having little threat to their validity then provide the evidence base for assessing the causal role of an exposure with the framework of the Hill criteria. Although beyond the scope of this article, there are also specific causal inference methods that can be applied to some of the more challenging causal problems in our field. 3 In addition, although one topic of particular importance in allergy/
