Emilia Gvozdenović1,2, Lucio Malvisi3, Elisa Cinconze3, Stijn Vansteelandt4,5, Phoebe Nakanwagi1, Emmanuel Aris1, Dominique Rosillon6. 1. GSK Vaccines, Rue Fleming 2, B-1300, Wavre, Belgium. 2. Present address: Galapagos Pharma, Mechelen, Belgium. 3. GSK Vaccines, Siena, Italy. 4. Ghent University, Ghent, Belgium. 5. London School of Hygiene and Tropical Medicine, London, UK. 6. GSK Vaccines, Rue Fleming 2, B-1300, Wavre, Belgium. Domi.rosillon@gmail.com.
Abstract
BACKGROUND: Randomized controlled trials are considered the gold standard to evaluate causal associations, whereas assessing causality in observational studies is challenging. METHODS: We applied Hill's Criteria, counterfactual reasoning, and causal diagrams to evaluate a potentially causal relationship between an exposure and outcome in three published observational studies: a) one burden of disease cohort study to determine the association between type 2 diabetes and herpes zoster, b) one post-authorization safety cohort study to assess the effect of AS04-HPV-16/18 vaccine on the risk of autoimmune diseases, and c) one matched case-control study to evaluate the effectiveness of a rotavirus vaccine in preventing hospitalization for rotavirus gastroenteritis. RESULTS: Among the 9 Hill's criteria, 8 (Strength, Consistency, Specificity, Temporality, Plausibility, Coherence, Analogy, Experiment) were considered as met for study c, 3 (Temporality, Plausibility, Coherence) for study a, and 2 (Temporary, Plausibility) for study b. For counterfactual reasoning criteria, exchangeability, the most critical assumption, could not be tested. Using these tools, we concluded that causality was very unlikely in study b, unlikely in study a, and very likely in study c. Directed acyclic graphs provided complementary visual structures that identified confounding bias and helped determine the most accurate design and analysis to assess causality. CONCLUSIONS: Based on our assessment we found causal Hill's criteria and counterfactual thinking valuable in determining some level of certainty about causality in observational studies. Application of causal inference frameworks should be considered in designing and interpreting observational studies.
BACKGROUND: Randomized controlled trials are considered the gold standard to evaluate causal associations, whereas assessing causality in observational studies is challenging. METHODS: We applied Hill's Criteria, counterfactual reasoning, and causal diagrams to evaluate a potentially causal relationship between an exposure and outcome in three published observational studies: a) one burden of disease cohort study to determine the association between type 2 diabetes and herpes zoster, b) one post-authorization safety cohort study to assess the effect of AS04-HPV-16/18 vaccine on the risk of autoimmune diseases, and c) one matched case-control study to evaluate the effectiveness of a rotavirus vaccine in preventing hospitalization for rotavirus gastroenteritis. RESULTS: Among the 9 Hill's criteria, 8 (Strength, Consistency, Specificity, Temporality, Plausibility, Coherence, Analogy, Experiment) were considered as met for study c, 3 (Temporality, Plausibility, Coherence) for study a, and 2 (Temporary, Plausibility) for study b. For counterfactual reasoning criteria, exchangeability, the most critical assumption, could not be tested. Using these tools, we concluded that causality was very unlikely in study b, unlikely in study a, and very likely in study c. Directed acyclic graphs provided complementary visual structures that identified confounding bias and helped determine the most accurate design and analysis to assess causality. CONCLUSIONS: Based on our assessment we found causal Hill's criteria and counterfactual thinking valuable in determining some level of certainty about causality in observational studies. Application of causal inference frameworks should be considered in designing and interpreting observational studies.
Authors: Cecilia M Roteli-Martins; Paulo Naud; Paola De Borba; Julio C Teixeira; Newton S De Carvalho; Toufik Zahaf; Nervo Sanchez; Brecht Geeraerts; Dominique Descamps Journal: Hum Vaccin Immunother Date: 2012-02-13 Impact factor: 3.452
Authors: Julie A Boom; Jacqueline E Tate; Leila C Sahni; Marcia A Rench; Jennifer J Hull; Jon R Gentsch; Manish M Patel; Carol J Baker; Umesh D Parashar Journal: Pediatrics Date: 2010-01-18 Impact factor: 7.124
Authors: Dominique Descamps; Karin Hardt; Bart Spiessens; Patricia Izurieta; Thomas Verstraeten; Thomas Breuer; Gary Dubin Journal: Hum Vaccin Date: 2009-05-20