Evidence map›Paper›PMID 33324996›Full record

ArticleEuropean journal of epidemiology2021

Assessing causality in epidemiology: revisiting Bradford Hill to incorporate developments in causal thinking.

Michal Shimonovich, Anna Pearce, Hilary Thomson, Katherine Keyes, Srinivasa Vittal Katikireddi

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European journal of epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
90citing papers in PubMed, 9 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

90 citing papers in PubMed, 9 syntheses or guidelines pooled it.

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  10. An exploration of the relationship between perceived injustice and pain severity in breast cancer survivors: a structural equation model.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
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  14. Early atherogenesis: In search of etiology.International journal of cardiology. Cardiovascular risk and prevention · 2026
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30 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Michal ShimonovichMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. 2405470s@student.gla.ac.uk.
Anna PearceMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
Hilary ThomsonMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
Katherine KeyesMailman School of Public Health, Columbia University, New York, NY, USA.
Srinivasa Vittal KatikireddiMRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.

Funding

As adolescent substance use declines, internalizing symptoms increase: identifying high-risk substance using groups and the role of social media, parental supervision, and unsupervised timeR01DA048853 · NIDA · COLUMBIA UNIVERSITY HEALTH SCIENCES · PI KEYES, KATHERINE M. · 2019 to 2023
$2.0M
Chief Scientist Office SPHSU15Chief Scientist Office SPHSU17Chief Scientist Office, Scottish Government Health and Social Care Directorate SPHSU13Medical Research Council MC_UU_00022/2Medical Research Council MC_UU_12017Medical Research Council MC_UU_12017/13Medical Research Council MC_UU_12017/15NHS Health Scotland SCAF/15/02NIDA NIH HHS R01 DA048853Wellcome Trust 205412Wellcome Trust 205412/Z/16/ZWellcome Trust (GB) 205412/Z/16/Z
6 · The paper itself

Abstract

The nine Bradford Hill (BH) viewpoints (sometimes referred to as criteria) are commonly used to assess causality within epidemiology. However, causal thinking has since developed, with three of the most prominent approaches implicitly or explicitly building on the potential outcomes framework: directed acyclic graphs (DAGs), sufficient-component cause models (SCC models, also referred to as 'causal pies') and the grading of recommendations, assessment, development and evaluation (GRADE) methodology. This paper explores how these approaches relate to BH's viewpoints and considers implications for improving causal assessment. We mapped the three approaches above against each BH viewpoint. We found overlap across the approaches and BH viewpoints, underscoring BH viewpoints' enduring importance. Mapping the approaches helped elucidate the theoretical underpinning of each viewpoint and articulate the conditions when the viewpoint would be relevant. Our comparisons identified commonality on four viewpoints: strength of association (including analysis of plausible confounding); temporality; plausibility (encoded by DAGs or SCC models to articulate mediation and interaction, respectively); and experiments (including implications of study design on exchangeability). Consistency may be more usefully operationalised by considering an effect size's transportability to a different population or unexplained inconsistency in effect sizes (statistical heterogeneity). Because specificity rarely occurs, falsification exposures or outcomes (i.e., negative controls) may be more useful. The presence of a dose-response relationship may be less than widely perceived as it can easily arise from confounding. We found limited utility for coherence and analogy. This study highlights a need for greater clarity on BH viewpoints to improve causal assessment.

Indexed as

CausalityComputer GraphicsData Interpretation, StatisticalDecision MakingEpidemiologic MethodsConfounding Factors, EpidemiologicHumansBradford HillCausal inferenceDirected acyclic graphsGRADESufficient component cause models

Identifiers

PMID33324996
PMCPMC8206235

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

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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.