Estimating neighborhood health effects: the challenges of causal inference in a complex world.
Estimating neighborhood health effects: the challenges of causal inference in a complex world.
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DOI：
10.1016/s0277-9536(03)00414-3
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发表时间：
2004-05-01
期刊：
影响因子：
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通讯作者：
Diez Roux, Ana V
中科院分区：
文献类型：
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作者：
Diez Roux, Ana V
奥克斯提出了一系列重要的问题，对过去的工作对邻里健康的影响的有效性，并建议该领域应该采取的方向（奥克斯，2003年）。事实上，将社区与个人水平结果联系起来的证据的有限性及其许多方法学问题已经在健康和其他领域得到了注意（Diez Roux，2001;邓肯& Raudenbush，1999; Furstenberg & Hughes，1997; Macintyre，Ellaway，&康明斯，2002; Sampson et al.，2002; Tienda，1991）。尽管如此，在估计因果邻近效应时所固有的复杂方法论问题仍然值得像奥克斯那样加以重申和阐述。我还想指出，奥克斯提出的许多问题是流行病学普遍存在的（以及其他领域的观察性研究），并不一定是关于邻里效应的研究所特有的（或他有时暗示的所谓“社会流行病学”）。也许问题之一是，在社区和健康的研究中（就像流行病学一样），“影响”这个词经常被松散地使用，导致人们的印象是，报告的关联总是有效的，并且是对可推广的因果参数的精确估计，当然，它们不是。我将开始对奥克斯在描述“邻域效应的因果模型”时提出的观点进行一些一般性评论。然后，我将总结与奥克斯指出的方法论障碍以及他提出的方法的一致和不一致。
Oakes raises a series of important questions on the validity of past work on neighborhood health effects and suggests directions the field should take (Oakes, 2003). Indeed the limited nature of the evidence linking neighborhoods to individual-level outcomes, and its many methodological problems, have been noted in health and other fields (Diez Roux, 2001; Duncan & Raudenbush, 1999; Furstenberg & Hughes, 1997; Macintyre, Ellaway, & Cummins, 2002; Sampson et al., 2002; Tienda, 1991). The complex methodological issues inherent in the estimation of causal neighborhood effects are nevertheless worth reiterating and elaborating on as Oakes does. I would also posit that many of the issues Oakes raises are common to epidemiology generally (and to observational studies in other fields) and are not necessarily specific to research on neighborhood effects (or to so-called ‘‘social epidemiology’’as he sometimes implies). Perhaps one of the problems is that in research on neighborhoods and health (as in epidemiology generally) the word ‘‘effects’’is often used loosely, leading to the impression that the associations reported are always valid and precise estimates of generalizable causal parameters, when of course they are not. I will begin with some general comments on points raised by Oakes when he describes ‘‘a causal model for neighborhood effects’’. I will then summarize agreements and disagreements with the methodological obstacles Oakes notes, and with the approaches he proposes.