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Criteria for Causation

"Scientists believe in proof without certainty; most people believe in certainty without proof." Ashely Montagu

Sir Bradford Hill established the following nine criteria for causation (does factor A cause disorder B). Although developed for use in the field of occupational medicine, these criteria can be used in most situations.

  1. Strength of the association. How large is the effect?

  2. The consistency of the association. Has the same association been observed by others, in different populations, using a different method?

  3. Specificity. Does altering only the cause alter the effect?

  4. Temporal relationship. Does the cause precede the effect?

  5. Biological gradient. Is there a dose response?

  6. Biological plausibility. Does it make sense?

  7. Coherence. Does the evidence fit with what is known regarding the natural history and biology of the outcome?

  8. Experimental evidence. Are there any clinical studies supporting the association?

  9. Reasoning by analogy. Is the observed association supported by similar associations?

References

Bradford-Hill A. The environment and disease: Assocation or causation? Proc R Soc Med 1965;58:295-300.

Grimes DA. Cause and effect - or coincidence? Contemporary OB/GYN Jan 1984;109-15.

Peterson HB, Kleinbaum DG. Interpreting the literature in Obstetrics and Gynecology: I. Key concepts in epidemiology and biostatistics. Obstet Gynecol 1991;78(4):710-17.

By Phil Hahn (November 22, 2004), Dept of Obstetrics & Gynaecology, Queen's University

Please direct comments re: Homepage to: Phil Hahn (Webmaster) phil.hahn@queensu.ca