Shpilberg O, Dorman J S, Ferrell R E, Trucco M, Shahar A, Kuller L H
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania 15261, USA.
J Clin Epidemiol. 1997 Jun;50(6):633-8. doi: 10.1016/s0895-4356(97)00052-8.
The traditional approach in epidemiology of relating exposure to an environmental agent such as a drug or infective agent has been to measure an overall risk (i.e., average and then "adjust risk for demographic variables and other confounders"). An attempt is sometimes made to define a "susceptible" subgroup. The analyses are usually based on good statistical methodology rather than an understanding of the interaction of body of host and agent. A twofold risk for 1000 exposed versus nonexposed people could be an average twofold risk for all 1000 exposed or a 20-fold risk for 100 exposed individuals (i.e., a drug-host interaction). Clearly, finding the 100 individuals with a 20-fold risk has much greater clinical importance than a twofold risk for 1000 people. The world of epidemiology may be changing-we may soon be able to define risk based on genetic susceptibility, at least sometimes.
流行病学中传统的方法是将暴露于环境因素（如药物或感染因子）与疾病联系起来，即测量总体风险（即平均风险，然后“根据人口统计学变量和其他混杂因素调整风险”）。有时会尝试定义一个“易感”亚组。分析通常基于良好的统计方法，而非对宿主与因素之间相互作用的理解。对于1000名暴露者和未暴露者而言，两倍的风险可能意味着所有1000名暴露者的平均风险为两倍，或者100名暴露个体的风险为20倍（即药物与宿主的相互作用）。显然，找出风险为20倍的100名个体比1000人的两倍风险具有更大的临床意义。流行病学领域可能正在发生变化——至少在某些情况下，我们或许很快就能基于基因易感性来定义风险。
