Exposure-wide epidemiology: revisiting Bradford Hill
Exposure-wide epidemiology: revisiting Bradford Hill
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DOI：
10.1002/sim.6825
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发表时间：
2016-05-20
影响因子：
2
通讯作者：
Ioannidis, John P. A.
中科院分区：
文献类型：
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作者：
Ioannidis, John P. A.
50年前，布拉德福德·希尔（Bradford Hill）发表了他极具影响力的标准，为区分因果关系提供了一些指导，50年后，我们积累了数百万篇关于依赖流行病学方法和原理的观察研究的论文和大量数据。这使我们能够重新检查九个标准的积累的经验证据，并通过透镜的全范围的方法重新处理流行病学。讲座讨论了这些流行病学方法的演变，并试图使用元流行病学评估的证据来重新评估九个标准中的每一个，以及它们是否能很好地作为因果关系的指南。我认为，在这九个标准中，实验仍然很重要，一致性（复制）也很重要。时间性也是有意义的，但通常很难记录。在其他六个标准中，强度大多不起作用，甚至可能需要反转：小的甚至是微小的效应比大的效应更合理;当看到大的效应时，它们大多是短暂的，几乎总是代表偏见和错误。在自然界中，几乎没有证据表明因果关系具有特异性。生物梯度通常不清楚它应该如何建模，因此很难证明。协调一致通常仍不清楚如何运作。最后，可类比性和类比在大多数调查领域都不起作用，尽管可能存在例外情况，但它们的援引大多是有害的。版权所有（c）2015约翰威利父子有限公司
Fiftyyears after Bradford Hill published his extremely influential criteria to offer some guides for separating causation from association, we have accumulated millions of papers and extensive data on observational research that depends on epidemiologic methods and principles. This allows us to re-examine the accumulated empirical evidence for the nine criteria, and to re-approach epidemiology through the lens of exposure-wide approaches. The lecture discusses the evolution of these exposure-wide approaches and tries to use the evidence from meta-epidemiologic assessments to reassess each of the nine criteria and whether they work well as guides for causation. I argue that of the nine criteria, experiment remains important and consistency (replication) is also very essential. Temporality also makes sense, but it is often difficult to document. Of the other six criteria, strength mostly does not work and may even have to be inversed: small and even tiny effects are more plausible than large effects; when large effects are seen, they are mostly transient and almost always represent biases and errors. There is little evidence for specificity in causation in nature. Biological gradient is often unclear how it should it modeled and thus difficult to prove. Coherence remains usually unclear how to operationalize. Finally, plausibility as well as analogy do not work well in most fields of investigation, and their invocation has been mostly detrimental, although exceptions may exist. Copyright (c) 2015 John Wiley & Sons, Ltd.