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Causal Inference: The Case of Hygiene and Health

Citation

Aiello, Allison E. & Larson, Elaine L. (2002). Causal Inference: The Case of Hygiene and Health. American Journal of Infection Control, 30(8), 503-10.

Abstract

A fundamental goal of applied epidemiology is to determine whether a relationship between 2 factors is causal. For example, the primary purpose of an outbreak investigation is to identify what factor(s) “caused” the problem, and the purpose of the Study of the Efficacy of Nosocomial Infection Control (SENIC Project) was to measure the effect of infection control and prevention programs on rates of nosocomial infections (ie, whether strong programs were associated with or “caused” a reduction in infections).1 There have been a number of historic efforts to formulate methods for valid causal inference.2, 3, 4 and 5 To the layperson, association between 2 variables is often assumed to be causal, but from the epidemiologic point of view, this is not the case. For example, in studies concerning health and hygiene, associations have been found between hand hygiene interventions and a decline in diarrhea and between laundering practices and prevalence of infectious disease in the home.6, 7, 8 and 9 Such associations, however, must properly reflect an underlying causal mechanism and must have been investigated with use of rigorous methodologic procedures.10, 11 and 12 Our purpose is to discuss 1 of the historic methods devised for inferring causation and the epidemiologic concepts that relate to causal inference, with the example of health and hygiene.

URL

https://doi.org/10.1067/mic.2002.124585

Reference Type

Journal Article

Journal Title

American Journal of Infection Control

Author(s)

Aiello, Allison E.
Larson, Elaine L.

Year Published

2002

Volume Number

30

Issue Number

8

Pages

503-10

Reference ID

8418