Disease causality


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Disease causality


Evaluation of diagnostic tests

Sensitivity and specificity

Positive and negative predictive value

Test precision and accuracy

Epidemiological measurements

Incidence and prevalence

Relative and absolute risk

Odds ratio

Attributable risk (AR)

Mortality rates and case-fatality


Direct standardization

Indirect standardization

Study design

Study designs

Ecologic study

Cross sectional study

Case-control study

Cohort study

Randomized control trial

Clinical trials

Sample size

Placebo effect and masking

Causation, validity and bias

Disease causality

Selection bias

Information bias



Bias in interpreting results of clinical studies

Bias in performing clinical studies

Public health

Modes of infectious disease transmission

Outbreak investigations

Disease surveillance

Vaccination and herd immunity



Disease causality


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USMLE® Step 2 questions

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High Yield Notes

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Disease causality

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USMLE® Step 1 style questions USMLE

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USMLE® Step 2 style questions USMLE

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A study is conducted in patients with acute myocardial infarction but no history of diabetes mellitus. The study examines the relationship between blood glucose level at admission and the number of episodes of ventricular arrhythmia during the first 24 hours after admission. Analysis of the results reveal a correlation coefficient of r = 0.85 (p <0.05). Which of the following is true about the relationship between blood glucose level and the number of episodes of ventricular arrhythmia?  

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Content Reviewers

Rishi Desai, MD, MPH


Sam Gillespie, BSc

Tanner Marshall, MS

Pauline Rowsome, BSc (Hons)

One of the main goals of epidemiology is to identify causal relationships between outcomes - like death, diseases, or injuries - and exposures - like smoking cigarettes, eating junk food, or drinking alcohol.

For example, nowadays, it’s widely known that smoking cigarettes causes lung cancer, or in other words, that smoking cigarettes leads to the development of lung cancer in many people. But how did we figure this out?

In the mid- 1950’s, an epidemiologist named Sir Austin Bradford Hill came up with nine guidelines for determining whether or not two things are causally related, and these are called the Bradford Hill Criteria.

The first criterion refers to the strength of association, and says that two things are more likely to be causally related if the strength of association between them is large.

For example, for people who smoke, the relative risk of lung cancer is around 25, meaning people that smoke have 25 times the risk of developing lung cancer compared to people that don’t smoke.

On the flip side, the relative risk of breast cancer for people who smoke is only about 1.5, which is much lower than the relative risk of lung cancer.

So, smoking is much more likely to cause lung cancer than it is to cause breast cancer.

The second criterion states that causal relationships are dose- dependent, meaning a person who has higher amounts of exposure will also have a higher risk of developing the outcome.

For example, the relative risk of lung cancer for people who smoke 10 cigarettes per day might be 8, the relative risk of lung cancer for people who smoke 15 cigarettes per day might be 13, and the relative risk of lung cancer for people who smoke 20 cigarettes per day might be 22.


Causality refers to a consequential relationship between two things. Disease causality is the relationship between a disease and its cause. A disease may have multiple causes, which can be categorized as either direct or indirect. Direct causes are those responsible for the initiation or aggravation of the disease process, while indirect causes predispose an individual to the development of a disease. Identifying the cause of a disease is essential to its treatment.


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