Lesko Catherine R, Fox Matthew P
Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
Departments of Epidemiology & Global Health, Boston University, Boston, MA.
Am J Epidemiol. 2024 Sep 17. doi: 10.1093/aje/kwae367.
In 1965, Sir Austin Bradford Hill articulated nine viewpoints for evaluating whether a body of evidence about the relationship between an exposure and outcome should be interpreted causally. In this commentary, we highlight a selection of the ways in which these viewpoints have had an impact on the field of epidemiology in terms of methods development, study design, and interpretation of results. Additionally, we opine on how the viewpoints relate to our understanding of basic epidemiologic concepts - for example, our choice of absolute or relative measures of effect, our evolving understanding of the role of context in the generalizability of study results, and modern epistemologies for causal inference (i.e., the potential outcomes framework and graphical causal models). Hill cautioned his audience that evidence should be weighed according to the policy choice it would inform and the context in which that policy would be implemented. We root our remarks in considerations of the public health impact of our conclusions about the causal nature of an observed relationship.
1965年，奥斯汀·布拉德福德·希尔爵士阐述了九个观点，用于评估关于暴露与结果之间关系的证据是否应被因果性地解释。在这篇评论中，我们重点介绍这些观点在方法开发、研究设计和结果解释方面对流行病学领域产生影响的一些方式。此外，我们还就这些观点如何与我们对基本流行病学概念的理解相关联发表看法——例如，我们对效应的绝对或相对测量指标的选择、我们对背景在研究结果可推广性中作用的不断演变的理解，以及因果推断的现代认识论（即潜在结果框架和图形因果模型）。希尔告诫听众，证据应根据其将为政策选择提供的信息以及该政策将在其中实施的背景来权衡。我们的论述基于对我们关于观察到的关系的因果性质的结论对公共卫生影响的考量。
