Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, 1200 Main Street West, Hamilton, Ontario, Canada.
J Epidemiol Community Health. 2011 May;65(5):392-5. doi: 10.1136/jech.2010.119933. Epub 2010 Oct 14.
This article describes how the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and strength of recommendations considers the Bradford Hill criteria for causation and how GRADE may relate to questions in public health. A primary concern in public health is that evidence from non-randomised studies may provide a more adequate or best available measure of a public health strategy's impact, but that such evidence might be graded as lower quality in the GRADE framework. GRADE, however, presents a framework that describes both criteria for assessing the quality of research evidence and the strength of recommendations that includes considerations arising from the Bradford Hill criteria. GRADE places emphasis on recommendations and in assessing quality of evidence; GRADE notes that randomisation is only one of many relevant factors. This article describes how causation may relate to developing recommendations and how the Bradford Hill criteria are considered in GRADE, using examples from the public health literature with a focus on immunisation.
本文描述了循证医学中的推荐评估、制定和评估（GRADE）方法如何对证据质量和推荐强度进行分级，以及考虑了因果关系的布拉德福·希尔标准，同时探讨了 GRADE 与公共卫生问题的关系。公共卫生的主要关注点是，非随机研究的证据可能提供了更充分或最佳的公共卫生策略影响的衡量标准，但在 GRADE 框架中，此类证据可能被评为质量较低。然而，GRADE 提出了一个框架，描述了评估研究证据质量和推荐强度的标准，其中包括了来自布拉德福·希尔标准的考虑因素。GRADE 强调了建议和评估证据质量；GRADE 指出，随机化只是许多相关因素之一。本文使用来自免疫接种等公共卫生文献中的示例，描述了因果关系如何与制定建议相关，以及 GRADE 中如何考虑布拉德福·希尔标准。
