ArticleClinical epidemiology2017
Effect modification, interaction and mediation: an overview of theoretical insights for clinical investigators.
Article in Clinical epidemiology, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 116 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
116 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Pooled it
- Stereoscopic three-dimensional visualisation technology in anatomy learning: A meta-analysis.Medical education · 2021Pooled it
- Getting the most out of intensive longitudinal data: a methodological review of workload-injury studies.BMJ open · 2018Pooled it
- Infant gut microbiota characteristics generally do not modify effects of lipid-based nutrient supplementation on growth or inflammation: secondary analysis of a randomized controlled trial in Malawi.Scientific reports · 2020Trial
- The role of socioeconomic status and pre-pregnancy BMI in postpartum psychiatric episodes - a mediation study.Social psychiatry and psychiatric epidemiology · 2026Article
- Evaluating the risk of elevated IL-6 levels in pediatric patients: a stratified approach and evidence of interaction effects.Translational pediatrics · 2026Article
- The intersecting effects of race/ethnicity, wealth, education, and gender on AIDS among 28.3 million Brazilians.Nature communications · 2026Article
- Geographical barriers to surgical treatment for cataract among California Medicare beneficiaries.Journal of cataract and refractive surgery · 2026Article
- Does inhaled nitric oxide treatment of pulmonary hypertension in extremely premature infants improve patient outcomes?Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Reduced cytochrome P-450 (CYP) 2D6 activity and Plasmodium vivax malaria risk in Amazonians: A retrospective, population-based cohort study.PLoS neglected tropical diseases · 2026Article
- Major adverse cardiovascular events, morbidity, and mortality, among people living with and without HIV in two northern Uganda hospitals.BMC infectious diseases · 2026Article
- Review no. 1: designing clinical kidney research using real-world data: research questions, data sources, and analytical skills.Clinical and experimental nephrology · 2026Review
- Interactive effects of systemic inflammation and nutritional status on 1-year functional outcomes in acute ischaemic stroke: a multidimensional biomarker cohort study.Frontiers in nutrition · 2026Article
- Early Menarche and Hypertension Among Postmenopausal Women: The Mediating Role of Obesity.Epidemiologia (Basel, Switzerland) · 2025Article
- 'Too much, too little' - heat wave impact during pregnancy and the need for adaptation measures.Global health action · 2025Article
- Interaction and Effect Modification in Clinical and Epidemiological Studies: Part 38 of a Series on the Evaluation of Scientific Publications.Deutsches Arzteblatt international · 2025Review
- Multilevel Estimation of the Relative Impacts of Social Determinants on Income-Related Health Inequalities in Urban Canada: Protocol for the Canadian Social Determinants Urban Laboratory.JMIR research protocols · 2025Article
- Trends and effectiveness of digital health management in postdischarge coronary artery disease across COVID19 pandemic.NPJ digital medicine · 2025Article
- Association of preoperative chronic opioid use with 1-year revision rate, mortality, and patient-reported outcomes after primary hip and knee arthroplasty: age, sex and BMI matter - a Dutch register-based study.Acta orthopaedica · 2025Article
- Birth size modifies longitudinal associations between midlife educational level and physical function at late-life for men and women.BMC geriatrics · 2025Article
56 more citing papers are in PubMed but not listed here.
Corrections and comments
- Erratum issued
- Erratum issued
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
We revisited the three interrelated epidemiological concepts of effect modification, interaction and mediation for clinical investigators and examined their applicability when using research databases. The standard methods that are available to assess interaction, effect modification and mediation are explained and exemplified. For each concept, we first give a simple "best-case" example from a randomized controlled trial, followed by a structurally similar example from an observational study using research databases. Our explanation of the examples is based on recent theoretical developments and insights in the context of large health care databases. Terminology is sometimes ambiguous for what constitutes effect modification and interaction. The strong assumptions underlying the assessment of interaction, and particularly mediation, require clinicians and epidemiologists to take extra care when conducting observational studies in the context of health care databases. These strong assumptions may limit the applicability of interaction and mediation assessments, at least until the biases and limitations of these assessments when using large research databases are clarified.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.