ReviewInternational journal of epidemiology2021
Use of directed acyclic graphs (DAGs) to identify confounders in applied health research: review and recommendations.
Review in International journal of epidemiology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 527 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
527 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Applications of causal and structural equation modeling in epidemiology: a systematic and critical review.BMC medical research methodology · 2026Pooled it
- Estimating Causal Effects of Third-Stage Management on Postpartum Haemorrhage in a Midwifery Context: An Evidence Synthesis Approach for Constructing Directed Acyclic Graphs.Paediatric and perinatal epidemiology · 2026Pooled it
- Observational studies of early versus late salvage therapies in critical care exhibit intrinsic selection bias: two meta-analyses.Critical care (London, England) · 2025Pooled it
- Baseline determinants of adherence for drug-sensitive TB treatment in a South African prospective cohort: a focus on HIV infection and anti-retroviral therapy, clinical care access, and TB stigma.BMC infectious diseases · 2026Trial
- Risk of Tuberculosis Infection in Young Children Exposed to Multidrug-resistant Tuberculosis in the TB-CHAMP Multi-site Randomized Controlled Trial.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2025Trial
- Association of Shoe Cushioning Perception and Comfort With Injury Risk in Leisure-Time Runners: A Secondary Analysis of a Randomised Trial.European journal of sport science · 2025Trial
- Diurnal Urinary Aldosterone Excretion and Potassium Intake During Pregnancy Are Associated With High Normal Blood Pressure in Early Childhood.Journal of the American Heart Association · 2025Trial
- Body mass index and hospital mortality in mechanically ventilated patients with acute hypoxaemic respiratory failure: A retrospective cohort study.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2026Article
- Symptom interactions and candidate intervention targets in patients with esophageal cancer: Network analysis with computer-simulated interventions.Asia-Pacific journal of oncology nursing · 2026Article
- Long-Term Opioid and Gabapentinoid Related Harms in CKD.Kidney international reports · 2026Article
- Real-world effectiveness of HPV vaccination against high-risk type HPV DNA positivity among adult women aged 18 - 45years in China: A matched test-negative design study.Human vaccines & immunotherapeutics · 2026Article
- Visceral adipose tissue and incident cardiovascular disease among individuals without diabetes: an analysis of 15 prospective cohorts from 7 countries in Latin America.Lancet regional health. Americas · 2026Article
- Early maternal depressive symptoms and child developmental outcomes at six years old: a prospective birth cohort study in a low-risk population.World journal of pediatrics : WJP · 2026Article
- Association between thyroid hormone T3 and aggression in drug-naïve schizophrenia: a directed acyclic graph analysis.European archives of psychiatry and clinical neuroscience · 2026Article
- Maternal Influenza Infection During Pregnancy and Neuropsychiatric Disorders in Offspring.JAMA network open · 2026Article
- Treatment outcomes and post-treatment mortality among people with multidrug/rifampicin-resistant tuberculosis in Sierra Leone: a national cohort study.The Lancet regional health. Africa · 2026Article
- Did You Know That Confounding Could Bias Results Obtained within an Economic Evaluation?Medical decision making : an international journal of the Society for Medical Decision Making · 2026Article
- Recommendations for the analysis of leading indicators in epidemic surveillance.PLOS digital health · 2026Review
- Plasma Vitamin D and Intermediate Age-Related Macular Degeneration: Insights from the Longitudinal ALIENOR Study.Ophthalmology science · 2026Article
- Depressive and insomnia symptoms and incident dementia risk: A 12-year study in U.S. older adults.Journal of affective disorders · 2026Article
467 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
13 authors.
Funding
Abstract
backgroundDirected acyclic graphs (DAGs) are an increasingly popular approach for identifying confounding variables that require conditioning when estimating causal effects. This review examined the use of DAGs in applied health research to inform recommendations for improving their transparency and utility in future research.
methodsOriginal health research articles published during 1999-2017 mentioning 'directed acyclic graphs' (or similar) or citing DAGitty were identified from Scopus, Web of Science, Medline and Embase. Data were extracted on the reporting of: estimands, DAGs and adjustment sets, alongside the characteristics of each article's largest DAG.
resultsA total of 234 articles were identified that reported using DAGs. A fifth (n = 48, 21%) reported their target estimand(s) and half (n = 115, 48%) reported the adjustment set(s) implied by their DAG(s). Two-thirds of the articles (n = 144, 62%) made at least one DAG available. DAGs varied in size but averaged 12 nodes [interquartile range (IQR): 9-16, range: 3-28] and 29 arcs (IQR: 19-42, range: 3-99). The median saturation (i.e. percentage of total possible arcs) was 46% (IQR: 31-67, range: 12-100). 37% (n = 53) of the DAGs included unobserved variables, 17% (n = 25) included 'super-nodes' (i.e. nodes containing more than one variable) and 34% (n = 49) were visually arranged so that the constituent arcs flowed in the same direction (e.g. top-to-bottom).
conclusionThere is substantial variation in the use and reporting of DAGs in applied health research. Although this partly reflects their flexibility, it also highlights some potential areas for improvement. This review hence offers several recommendations to improve the reporting and use of DAGs in future research.
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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.