Weinberg Clarice R
National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709, USA.
Epidemiology. 2007 Sep;18(5):569-72. doi: 10.1097/EDE.0b013e318126c11d.
The system proposed by VanderWeele and Robins for categorization of effect modifiers that are causal nodes in a directed acyclic graph (DAG) was not intended to empower DAGs to fully represent complex interactions among causes. However, once one has algebraically identified effect modifiers, the DAG implies a role for them. The limitations of epidemiologic definitions of "effect modification" are discussed, along with the implications of scale dependency for assessing interactions, where the scale can be either absolute risk, relative risk, or odds. My view is that probabilistic independence leads to the log-complement as a natural scale for interaction, but even that scale does not necessarily admit unambiguous inference. Any 2 direct causes of D are effect modifiers for each other on at least 2 scales, which can make a reasonable person question the utility of the concept. Still, etiologic models for joint effects are important, because most diseases arise through pathways involving multiple factors. I suggest an enhancement in construction of DAGs in epidemiology that includes arrow-on-arrow representations for effect modification. Examples are given, some of which depend on scale and some of which do not. An example illustrates possible biologic implications for such an effect modification DAG.
范德韦勒和罗宾斯提出的用于对有向无环图(DAG)中作为因果节点的效应修饰因素进行分类的系统,并非旨在使DAG能够完全表示原因之间的复杂相互作用。然而,一旦通过代数方法确定了效应修饰因素,DAG就暗示了它们的作用。文中讨论了“效应修饰”的流行病学定义的局限性,以及尺度依赖性对评估相互作用的影响,这里的尺度可以是绝对风险、相对风险或比值比。我的观点是,概率独立性导致对数互补作为相互作用的自然尺度,但即使是那个尺度也不一定能进行明确的推断。D的任何两个直接原因在至少两个尺度上互为效应修饰因素,这可能会让一个理性的人质疑这个概念的实用性。尽管如此,联合效应的病因模型很重要,因为大多数疾病是通过涉及多个因素的途径产生的。我建议在流行病学中改进DAG的构建,包括用于效应修饰的箭对箭表示法。文中给出了一些例子,其中一些取决于尺度,一些则不取决于尺度。一个例子说明了这种效应修饰DAG可能的生物学意义。