Emerg Themes Epidemiol. 2013 Dec 06;10(1):13. doi: 10.1186/1742-7622-10-13.
Diagram-based Analysis of Causal Systems (DACS): elucidating inter-relationships between determinants of acute lower respiratory infections among children in sub-Saharan Africa.
Emerging themes in epidemiology
Eva A Rehfuess, Nicky Best, David J Briggs, Mike Joffe
Affiliations
Affiliations
- MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK. [email protected].
PMID: 24314302
PMCID: PMC3904753 DOI: 10.1186/1742-7622-10-13
Abstract
BACKGROUND: Effective interventions require evidence on how individual causal pathways jointly determine disease. Based on the concept of systems epidemiology, this paper develops Diagram-based Analysis of Causal Systems (DACS) as an approach to analyze complex systems, and applies it by examining the contributions of proximal and distal determinants of childhood acute lower respiratory infections (ALRI) in sub-Saharan Africa.
RESULTS: Diagram-based Analysis of Causal Systems combines the use of causal diagrams with multiple routinely available data sources, using a variety of statistical techniques. In a step-by-step process, the causal diagram evolves from conceptual based on a priori knowledge and assumptions, through operational informed by data availability which then undergoes empirical testing, to integrated which synthesizes information from multiple datasets. In our application, we apply different regression techniques to Demographic and Health Survey (DHS) datasets for Benin, Ethiopia, Kenya and Namibia and a pooled World Health Survey (WHS) dataset for sixteen African countries. Explicit strategies are employed to make decisions transparent about the inclusion/omission of arrows, the sign and strength of the relationships and homogeneity/heterogeneity across settings.Findings about the current state of evidence on the complex web of socio-economic, environmental, behavioral and healthcare factors influencing childhood ALRI, based on DHS and WHS data, are summarized in an integrated causal diagram. Notably, solid fuel use is structured by socio-economic factors and increases the risk of childhood ALRI mortality.
CONCLUSIONS: Diagram-based Analysis of Causal Systems is a means of organizing the current state of knowledge about a specific area of research, and a framework for integrating statistical analyses across a whole system. This partly a priori approach is explicit about causal assumptions guiding the analysis and about researcher judgment, and wrong assumptions can be reversed following empirical testing. This approach is well-suited to dealing with complex systems, in particular where data are scarce.
References
- IMA J Math Appl Med Biol. 1994;11(3):161-92 - PubMed
- Trop Med Parasitol. 1992 Dec;43(4):229-33 - PubMed
- Int J Epidemiol. 2010 Jun;39(3):795-808 - PubMed
- Lancet. 2007 Jul 21;370(9583):285-289 - PubMed
- Int J Epidemiol. 1993 Dec;22(6):1174-82 - PubMed
- Proc Natl Acad Sci U S A. 2010 Dec 28;107(52):22605-10 - PubMed
- BMC Public Health. 2006 May 05;6:125 - PubMed
- Environ Health Perspect. 2014 Feb;122(2):120-30 - PubMed
- Soc Sci Med. 2003 Dec;57(12):2255-64 - PubMed
- Int J Epidemiol. 1998 Apr;27(2):255-60 - PubMed
- Lancet. 2007 Nov 10;370(9599):1653-63 - PubMed
- Health Place. 2007 Mar;13(1):205-23 - PubMed
- Soc Sci Med. 2003 Apr;56(8):1677-91 - PubMed
- Soc Sci Med. 2003 Nov;57(9):1529-38 - PubMed
- Int J Epidemiol. 2008 Aug;37(4):805-15 - PubMed
- BMC Public Health. 2005 Mar 03;5:20 - PubMed
- Epidemiol Infect. 2002 Aug;129(1):65-71 - PubMed
- Lancet. 2005 Mar 26-Apr 1;365(9465):1147-52 - PubMed
- Ann Epidemiol. 2007 Jul;17(7):569-74 - PubMed
- BMC Public Health. 2010 Aug 17;10:491 - PubMed
- Lancet. 2011 Nov 12;378(9804):1717-26 - PubMed
- J R Stat Soc Ser A Stat Soc. 1998;161(3):349-66 - PubMed
- Public Health Nutr. 2000 Mar;3(1):39-47 - PubMed
- Health Educ Res. 1991 Jun;6(2):163-71 - PubMed
- J Natl Cancer Inst. 2010 Feb 3;102(3):202-6 - PubMed
- Int J Epidemiol. 1996 Aug;25(4):885-93 - PubMed
- Indian J Pediatr. 2005 Jun;72(6):481-7 - PubMed
- BMC Pediatr. 2007 Mar 01;7:10 - PubMed
- Ann Trop Paediatr. 1992;12(4):421-32 - PubMed
- Bull World Health Organ. 2004 May;82(5):320 - PubMed
- Econ Hum Biol. 2008 Dec;6(3):398-419 - PubMed
- PLoS One. 2013 Nov 04;8(11):e78692 - PubMed
- Emerg Themes Epidemiol. 2011 Jan 20;8(1):2 - PubMed
- Am J Public Health. 2006 Mar;96(3):473-9 - PubMed
- Epidemiology. 1999 Jan;10(1):37-48 - PubMed
- Lancet. 2012 Dec 15;380(9859):2095-128 - PubMed
- Int J Epidemiol. 2010 Feb;39(1):97-106 - PubMed
- Int J Epidemiol. 2007 Aug;36(4):713-7 - PubMed
- Pediatrics. 1994 Jun;93(6 Pt 1):977-85 - PubMed
- Demography. 1998 Feb;35(1):71-81 - PubMed
- Bull World Health Organ. 2008 May;86(5):322-2A - PubMed
- Cad Saude Publica. 2004 Sep-Oct;20(5):1182-90 - PubMed
- Cad Saude Publica. 2010 Dec;26(12):2251-62 - PubMed
- Bull World Health Organ. 2008 May;86(5):356-64 - PubMed
- Am J Epidemiol. 2009 May 15;169(10):1182-90 - PubMed
- Bull World Health Organ. 2000;78(1):30-41 - PubMed
- Bull World Health Organ. 2008 May;86(5):390-398C - PubMed
- J Health Popul Nutr. 2005 Sep;23(3):222-30 - PubMed
- J Epidemiol Community Health. 2011 Jul;65(7):576-81 - PubMed
- PLoS Med. 2008 Mar 4;5(3):e52 - PubMed
- J Am Coll Cardiol. 2010 Aug 31;56(10):789-95 - PubMed
- Bull World Health Organ. 2008 May;86(5):381-9 - PubMed
- Environ Health Perspect. 2012 May;120(5):637-45 - PubMed
- Int J Epidemiol. 2000 Aug;29(4):722-9 - PubMed
- Epidemiology. 2008 Sep;19(5):720-8 - PubMed
- Bull World Health Organ. 2008 May;86(5):349-55 - PubMed
- Epidemiology. 2001 May;12(3):313-20 - PubMed
- J Clin Epidemiol. 2001 Apr;54(4):325-31 - PubMed
- BMJ. 2005 Nov 19;331(7526):1180-2 - PubMed
- J Trop Pediatr. 2004 Oct;50(5):260-70 - PubMed
- Int J Epidemiol. 2009 Apr;38(2):538-48 - PubMed
- Soc Sci Med. 2005 Jan;60(2):395-407 - PubMed
- Bull World Health Organ. 2000;78(10):1256-70 - PubMed
- Epidemiology. 2005 Jan;16(1):114-20 - PubMed
- Am J Epidemiol. 2008 Jul 1;168(1):1-8 - PubMed
- Lancet. 2007 Nov 3;370(9598):1569-77 - PubMed
- Soc Sci Med. 1994 Oct;39(7):887-903 - PubMed
- Bull World Health Organ. 2000;78(1):19-29 - PubMed
- J Health Popul Nutr. 2006 Mar;24(1):89-99 - PubMed
- Am J Public Health. 2006 Nov;96(11):2055-60 - PubMed
- J Epidemiol Community Health. 2009 Nov;63(11):887-92 - PubMed
- Am J Trop Med Hyg. 2007 Mar;76(3):585-91 - PubMed
- J Trop Pediatr. 1994 Aug;40(4):201-6 - PubMed
- Int J Epidemiol. 2005 Jun;34(3):638-9 - PubMed
- Emerg Themes Epidemiol. 2012 Mar 19;9(1):1 - PubMed
- Soc Sci Med. 1993 May;36(9):1207-27 - PubMed
- Stat Med. 2013 Jul 10;32(15):2555-70 - PubMed
- Public Health. 2005 Oct;119(10):862-9 - PubMed
Publication Types