MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
Int J Epidemiol. 2017 Jun 1;46(3):1057-1062. doi: 10.1093/ije/dyw329.
Life course epidemiology has used models of accumulation and critical or sensitive periods to examine the importance of exposure timing in disease aetiology. These models are usually used to describe the direct effects of exposures over the life course. In comparison with consideration of direct effects only, we show how consideration of total effects improves interpretation of these models, giving clearer notions of when it will be most effective to intervene. We show how life course variation in the total effects depends on the magnitude of the direct effects and the stability of the exposure. We discuss interpretation in terms of total, direct and indirect effects and highlight the causal assumptions required for conclusions as to the most effective timing of interventions.
生命历程流行病学使用积累模型和关键或敏感期模型来研究暴露时间在疾病发病机制中的重要性。这些模型通常用于描述一生中暴露的直接影响。与仅考虑直接影响相比，我们展示了如何考虑总效应可以改善对这些模型的解释，更清楚地说明何时进行干预最有效。我们展示了总效应在生命历程中的变化如何取决于直接效应的大小和暴露的稳定性。我们根据总效应、直接效应和间接效应来讨论解释，并强调了得出干预最有效时间结论所需的因果假设。
