Cited by 2,295Advanced Causal Inference TechniquesBayesian Modeling and Causal InferenceStatistical Methods in Epidemiology

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Robust causal inference using directed acyclic graphs: the R package ‘dagitty’

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Textor, Johannes, van der Zander, Benito, Gilthorpe, Mark S., Liśkiewicz, Maciej, Ellison, George T.H.·2017·International Journal of Epidemiology

DOI 10.1093/ije/dyw341

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Abstract

Directed acyclic graphs (DAGs), which offer systematic representations of causal relationships, have become an established framework for the analysis of causal inference in epidemiology, often being used to determine covariate adjustment sets for minimizing confounding bias. DAGitty is a popular web application for drawing and analysing DAGs. Here we introduce the R package 'dagitty', which provides access to all of the capabilities of the DAGitty web application within the R platform for statistical computing, and also offers several new functions. We describe how the R package 'dagitty' can be used to: evaluate whether a DAG is consistent with the dataset it is intended to represent; enumerate 'statistically equivalent' but causally different DAGs; and identify exposure-outcome adjustment sets that are valid for causally different but statistically equivalent DAGs. This functionality enables epidemiologists to detect causal misspecifications in DAGs and make robust inferences that remain valid for a range of different DAGs. The R package 'dagitty' is available through the comprehensive R archive network (CRAN) at [https://cran.r-project.org/web/packages/dagitty/]. The source code is available on github at [https://github.com/jtextor/dagitty]. The web application 'DAGitty' is free software, licensed under the GNU general public licence (GPL) version 2 and is available at [http://dagitty.net/].

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Peters, R. L., Kay, T., McWilliam, V. L., Lodge, C., Ponsonby, A., Dharmage, S. C., Lowe, A. J., & Koplin, J. J. (2020) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2020.09.006 · Cited by 19
Assessment of Incidence Rate and Risk Factors for Keratoacanthoma Among Residents of Queensland, Australia
Claeson, M., Pandeya, N., Dusingize, J. C., Thompson, B. S., Green, A. C., Neale, R. Ε., Olsen, C. M., & Whiteman, D. C. (2020) · JAMA Dermatology · doi:10.1001/jamadermatol.2020.4097 · Cited by 19
Infant pacifier sanitization and risk of challenge-proven food allergy: A cohort study
Soriano, V. X., Koplin, J. J., Forrester, M., Peters, R. L., O’Hely, M., Dharmage, S. C., Wright, R., Ranganathan, S., Burgner, D. P., Thompson, K., et al. (2021) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2021.01.032 · Cited by 19
Residential exposure to traffic-borne pollution as a risk factor for acute cardiocerebrovascular events: a population-based retrospective cohort study in a highly urbanized area
Magnoni, P., Murtas, R., & Russo, A. G. (2021) · International Journal of Epidemiology · doi:10.1093/ije/dyab068 · Cited by 19
Incidence, Mortality, and Risk Factors of COVID-19 in Nursing Homes
Arnedo-Pena, A., Romeu-García, M. Á., Gascó‐Laborda, J. C., Meseguer‐Ferrer, N., Safont-Adsuara, L., Prades-Vila, L., Flores-Medina, M., Rusen, V., Tirado-Balaguer, M. D., Sabater-Vidal, S., et al. (2022) · Epidemiologia · doi:10.3390/epidemiologia3020014 · Cited by 19
“The direct acyclic graph (DAG) approach with DAGitty version 3.0 (Johannes Textor, Nijmegen, The Netherlands) [20] was used to consider potential confounding factors in the multivariate analysis.”
MethodInfluential
Impact of therapeutic plasmapheresis on the duration of organ failure in patients with hypertriglyceridemia-associated acute pancreatitis
Wang, L., Zhou, J., Lv, C., Hong, D., Wang, Z., Mao, W., Liu, Y., Zhang, Z., Li, Y., Li, G., et al. (2024) · Annals of Intensive Care · doi:10.1186/s13613-024-01285-3 · Cited by 18
“A minimally sufficient adjustment set [24] in the DAG was identified by DAGitty software, version 3.0 (www. dagit ty. net).”
MethodInfluential
Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative)
Andreasen, C. H., Dahl, C., Frihagen, F., Borgen, T. T., Basso, T., Gjertsen, J., Figved, W., Wisløff, T. F., Hagen, G., Apalset, E. M., et al. (2025) · Osteoporosis International · doi:10.1007/s00198-024-07376-y · Cited by 18
“Confounders were mapped using a causal-directed acyclic graph [27].”
Information exchange in governance networks—Who brokers across political divides?
Angst, M., & Brandenberger, L. (2021) · Governance · doi:10.1111/gove.12601 · Cited by 18
Insights on Genetic and Environmental Factors in Parkinson’s Disease from a Regional Swedish Case-Control Cohort
Brolin, K. A., Bandrés‐Ciga, S., Blauwendraat, C., Widner, H., Odin, P., Hansson, O., Puschmann, A., & Swanberg, M. (2021) · Journal of Parkinson s Disease · doi:10.3233/jpd-212818 · Cited by 15
“Directed acyclic graphs (DAGs) were made for all exposures of interest using the R package ‘dagitty’ to help identify confounding variables to adjust for in the multivariate analyses (Supplementary Figure 3) [32].”
Ultrasound estimated subcutaneous and visceral adipose tissue thicknesses and risk of pre-eclampsia
Maack, H. P., Poromaa, I. S., Lindström, L., Mulic‐Lutvica, A., Junus, K., & Wikström, A. (2021) · Scientific Reports · doi:10.1038/s41598-021-02208-z · Cited by 18
Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation
Chmielewski, J., Chaudhry, P. M., Harer, M. W., Menon, S., South, A. M., Chappell, A., Griffin, R. L., Askenazi, D. J., Jetton, J. G., Starr, M. C., et al. (2022) · Journal of Perinatology · doi:10.1038/s41372-022-01424-3 · Cited by 18
“Our DAG-informed adjustment set identified birthweight, out-born status, and 5-minute APGAR score as minimally sufficient to close non-causal, biasing pathways [4, 11].”
Background
Relationship between handgrip strength and endogenous hormones in postmenopausal women
García-Alfaro, P., García, S., Rodríguez, I., Bergamaschi, L., & Pérez-López, F. R. (2022) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002093 · Cited by 19
Protective behavior and SARS-CoV-2 infection risk in the population – Results from the Gutenberg COVID-19 study
Baumkötter, R., Yılmaz, S., Zahn, D., Fenzl, K., Prochaska, J. H., Rossmann, H., Schmidtmann, I. M., Schuster, A. K.-G., Beutel, M. E., Lackner, K. J., et al. (2022) · BMC Public Health · doi:10.1186/s12889-022-14310-6 · Cited by 18
“Prior to analysis, a directed acyclic graph (DAG) was generated using DAGitty software [19].”
Method
Sedentarization and maternal childcare networks: role of risk, gender and demography
Page, A. E., Migliano, A. B., Dyble, M., Major‐Smith, D., Viguier, S., & Hassan, A. (2022) · Philosophical Transactions of the Royal Society B Biological Sciences · doi:10.1098/rstb.2021.0435 · Cited by 17
“We used directed acyclic graphs to illustrate the hypothesized causal relationships between variables and to identify which confounders to adjust for (see electronic supplementary material, figures S4 and S5) using the dagitty package [75].”
Method
Long-term aircraft noise exposure and risk of hypertension in postmenopausal women
Nguyen, D., Whitsel, E. A., Wellenius, G. A., Levy, J. I., Leibler, J. H., Grady, S. T., Stewart, J. D., Fox, M. P., Collins, J. M., Eliot, M., et al. (2022) · Environmental Research · doi:10.1016/j.envres.2022.115037 · Cited by 20
A pro-inflammatory diet in people with multiple sclerosis is associated with an increased rate of relapse and increased FLAIR lesion volume on MRI in early multiple sclerosis: A prospective cohort study
Saul, A., Taylor, B. V., Blizzard, L., Simpson, S., Oddy, W. H., Shivappa, N., Hébert, J. R., Black, L. J., Ponsonby, A., Broadley, S., et al. (2023) · Multiple Sclerosis Journal · doi:10.1177/13524585231167739 · Cited by 18
Target trial emulation to assess real-world efficacy in the Epidemiological Strategy and Medical Economics metastatic breast cancer cohort
Antoine, A., Pérol, D., Robain, M., Delaloge, S., Lasset, C., & Drouet, Y. (2023) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djad092 · Cited by 20
“We modeled our hypotheses with causal directed acyclic graph (DAG) using the DAGitty browser-based environment (16-19).”
Method
ALK Inhibitor Treatment Patterns and Outcomes in Real-World Patients with ALK-Positive Non-Small-Cell Lung Cancer: A Retrospective Cohort Study
Wang, M., Slatter, S., Sussell, J. A., Lin, C.-W., Ogale, S. S., Datta, D., Butte, A. J., Bazhenova, L. A., & Rudrapatna, V. A. (2023) · Targeted Oncology · doi:10.1007/s11523-023-00973-7 · Cited by 18
“Causal directed acyclic graphs (DAGs) [31] were constructed to develop the multivariate Cox regression models to estimate the median mAEFS, rwPFS, and OS and hazard ratios (HR) with 95% CI as the treatment effect of alectinib versus crizotinib on survival outcomes (Fig.”
Method
Associations of neighbourhood environmental attributes and socio-economic status with health-related quality of life in urban mid-aged and older adults: Mediation by physical activity and sedentary behaviour
Barnett, A. H., Shaw, J. E., Martino, E., Knibbs, L. D., Poudel, G. R., Owen, N. G., & Cerin, E. (2023) · Cities · doi:10.1016/j.cities.2023.104538 · Cited by 18
Prospective and Mendelian randomization analyses on the association of circulating fatty acid binding protein 4 (FABP-4) and risk of colorectal cancer
Nimptsch, K., Aleksandrova, K., Pham, T. T., Papadimitriou, N., Janke, J., Christakoudi, S., Heath, A. K., Olsen, A., Tjønneland, A. M., Schulze, M. B., et al. (2023) · BMC Medicine · doi:10.1186/s12916-023-03104-1 · Cited by 18
“A directed acyclic graph (DAG) was created using the DAGitty web application [38] to graphically illustrate the hypothesized causal pathways between FABP-4 and CRC risk and potentially confounding factors to be considered based on prior evidence [39].”
Method
Ultrafine particulate matter exposure during second year of life, but not before, associated with increased risk of autism spectrum disorder in BKMR mixtures model of multiple air pollutants
Goodrich, A. J., Kleeman, M. J., Tancredi, D. J., Ludeña, Y., Bennett, D. H., Hertz‐Picciotto, I., & Schmidt, R. J. (2023) · Environmental Research · doi:10.1016/j.envres.2023.117624 · Cited by 18
The untapped potential of causal inference in cross-modal research
Pan, J., Mahdavi, A., Miño-Rodríguez, I., Martínez-Muñoz, I., Berger, C., & Schweiker, M. (2023) · Building and Environment · doi:10.1016/j.buildenv.2023.111074 · Cited by 19
Association of Breastfeeding and Neonatal Jaundice With Infant Neurodevelopment
Ke, K., Chi, X., Lv, H., Zhao, J., Jiang, Y., Jiang, T., Lu, Q., Qiu, Y., Tao, S., Qin, R., et al. (2023) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2023.11.025 · Cited by 19
Reactivation of Kaposi’s sarcoma-associated herpesvirus (KSHV) by SARS-CoV-2 in non-hospitalised HIV-infected patients
Lambarey, H., Blumenthal, M. J., Chetram, A., Joyimbana, W., Jennings, L., Orrell, C., & Schäfer, G. (2024) · EBioMedicine · doi:10.1016/j.ebiom.2024.104986 · Cited by 18
Migraine or any headaches and white matter hyperintensities and their progression in women and men
Schramm, S. H., Tenhagen, I., Jokisch, M., Gronewold, J., Moebus, S., Caspers, S., Katsarava, Z., Erbel, R., Stang, A., & Schmidt, B. (2024) · The Journal of Headache and Pain · doi:10.1186/s10194-024-01782-7 · Cited by 18
“…1: adjusted for age; model 2: as model 1 + smoking status (never/past/current), BMI, sport (yes/ no) and years of education (according to the DAG [28] used to determine the minimal sufficient adjustment set, see Figure SM2); model 3: as model 2 + diabetes mellitus, systolic blood pressure, and…”
Method
Neurodevelopment and Metabolism in the Maternal-Placental-Fetal Unit
Parenti, M., Schmidt, R. J., Tancredi, D. J., Hertz‐Picciotto, I., Walker, C. K., & Slupsky, C. M. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.13399 · Cited by 18
The association of diet quality and physical activity with cardiovascular disease and mortality in 85,545 older Australians: A longitudinal study
Ding, D., Buskirk, J. V., Partridge, S. R., Clare, P. J., Giovannucci, E. L., Bauman, A. E., Freene, N., Gallagher, R. D., & Nguyen, B. (2024) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2024.05.011 · Cited by 19
“29 The following potential confounders were selected for adjustment: age; sex; marital status (single, married/de facto, widowed, divorce/ separated); country of birth (Australia vs. overseas); highest educational attainment (no school certiﬁcate, school certiﬁ-cate, higher school certiﬁcate,…”
Background
Causal Effect Identification from Multiple Incomplete Data Sources: A General Search-Based Approach
Tikka, S., Hyttinen, A., & Karvanen, J. (2021) · Journal of Statistical Software · doi:10.18637/jss.v099.i05 · Cited by 18
DNA methylation differences at birth after conception through ART
Tobi, E. W., Almqvist, C., Hedman, A. M., Andolf, E. G., Holte, J., Olofsson, J. I., Wramsby, H., Wramsby, M., Pershagen, G., Heijmans, B. T., et al. (2020) · Human Reproduction · doi:10.1093/humrep/deaa253 · Cited by 18
Use of health care services among Syrian refugees migrating to Norway: a prospective longitudinal study
Haj-Younes, J., Strømme, E. M., Igland, J., Abildsnes, E., Kumar, B. N., Hasha, W., & Díaz, E. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06571-5 · Cited by 18
“The DAG was constructed using the software DAGitty [22].”
Method
Parental preconception BMI trajectories from childhood to adolescence and asthma in the future offspring
Bowatte, G., Bui, D., Priyankara, S., Lowe, A. J., Perret, J. L., Lodge, C., Hamilton, G. S., Erbas, B., Thomas, P. S., Thompson, B., et al. (2022) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2021.11.028 · Cited by 18
Tick-Borne Encephalitis Risk Increases with Dog Ownership, Frequent Walks, and Gardening: A Case-Control Study in Germany 2018–2020
Nygren, T. M., Pilic, A., Böhmer, M. M., Wagner-Wiening, C., Wichmann, O., Harder, T., & Hellenbrand, W. (2022) · Microorganisms · doi:10.3390/microorganisms10040690 · Cited by 18
“We explored the underlying causal structure with directed acyclic graphs (DAGs) in Dagitty [18], to identify the minimal adjustment sets required to estimate the total causal effect for each exposure of interest on TBE risk (Supplementary Materials Figure S1.”
Background
Childhood ‘bronchitis’ and respiratory outcomes in middle-age: a prospective cohort study from age 7 to 53 years
Perret, J. L., Wurzel, D. F., Walters, E. H., Lowe, A. J., Lodge, C., Bui, D., Erbas, B., Bowatte, G., Russell, M. A., Thompson, B. R., et al. (2022) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2022-001212 · Cited by 21
“Children with a history of bronchitis trended to have fewer siblings and fewer”
Cross-sectional associations between lunch-type consumed on a school day and British adolescents’ overall diet quality
Taher, A. K., Ensaff, H., & Evans, C. E. L. (2020) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2020.101133 · Cited by 18
“A Directed Acyclic Graph (DAG) (Textor et al., 2016) (Supplemental Fig.”
Background
DoWhy: Addressing Challenges in Expressing and Validating Causal AssumptionsPreprint
Sharma, A. K., Syrgkanis, V., Zhang, C., & Kıcıman, E. (2021) · arXiv (Cornell University) · doi:10.48550/arxiv.2108.13518 · Cited by 18
“, 2012) and dagitty (Textor et al., 2016) focus on modeling; causaleffect (Tikka & Karvanen, 2017) on identification; and EconML (Keith Battocchi, 2019) and CausalML (Chen et al.”
Background
Beta-blocker use and acute exacerbations of COPD following myocardial infarction: a Danish nationwide cohort study
Rasmussen, D. B., Bødtger, U. C. S., Lamberts, M., Torp-Pedersen, C. T., Gislason, G., Lange, P., & Jensen, M. T. (2020) · Thorax · doi:10.1136/thoraxjnl-2019-214206 · Cited by 17
Time to antibiotic administration and patient outcomes in community-acquired pneumonia: results from a prospective cohort study
Fally, M., Israelsen, S. B., Benfield, T., Tarp, B., & Ravn, P. (2020) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2020.08.037 · Cited by 17
Association between emergency department pediatric readiness and transfer of noninjured children in small rural hospitals
Lieng, M. K., Marcin, J. P., Sigal, I. S., Haynes, S. C., Dayal, P., Tancredi, D. J., Gausche‐Hill, M., Mouzoon, J. L., Romano, P. S., & Rosenthal, J. L. (2021) · The Journal of Rural Health · doi:10.1111/jrh.12566 · Cited by 17
Risk factors for adverse outcomes among 35 879 veterans with and without diabetes after diagnosis with COVID-19
Wander, P. L., Lowy, E., Beste, L. A., Tulloch-Palomino, L. G., Korpak, A. M., Peterson, A. C., Young, B. A., & Boyko, E. J. (2021) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2021-002252 · Cited by 17
Fracture risk across a wide range of physical activity levels, from sedentary individuals to elite athletes
Stattin, K., Höijer, J., Hållmarker, U., Baron, J. A., Larsson, S. C., Wolk, A., Michaëlsson, K., & Byberg, L. (2021) · Bone · doi:10.1016/j.bone.2021.116128 · Cited by 17
“Covariates of interest were chosen using directed acyclic graphs [37,38].”
Impact of shift work on the risk of depression
Behrens, T., Burek, K., Rabstein, S., Wichert, K., Erbel, R., Eisele, L., Arendt, M., Dragano, N., Brüning, T., & Jöckel, K. (2021) · Chronobiology International · doi:10.1080/07420528.2021.1962903 · Cited by 17
“The DAG was drawn with the DAGitty software (Textor et al. 2016).”
Method
Relation between occupation, gender dominance in the occupation and workplace and suicide in Sweden: a longitudinal study
Santander, N. M., Blazevska, B., Carli, V., Hadlaczky, G., Linnersjö, A., Bodin, T., & Johansson, G. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-060096 · Cited by 17
Estimating the effect of donor sex on red blood cell transfused patient mortality: A retrospective cohort study using a targeted learning and emulated trials-based approach
Bruun‐Rasmussen, P., Andersen, P. K., Banasik, K., Brunak, S., & Johansson, P. I. (2022) · EClinicalMedicine · doi:10.1016/j.eclinm.2022.101628 · Cited by 17
The neighbourhood environment and profiles of the metabolic syndrome
Barnett, A. H., Martino, E., Knibbs, L. D., Shaw, J. E., Dunstan, D. W., Magliano, D. J., Donaire-González, D., & Cerin, E. (2022) · Environmental Health · doi:10.1186/s12940-022-00894-4 · Cited by 19
“A1) [52], based on the hypothesised causal effects among the neighbourhood variables according to previous studies and the authors’ expert opinion, was created to determine the minimal set of confounders for regression models of total and direct, independent effects of neighbourhood environment…”
Method
Validating Causal Diagrams of Human Health Risks for Spaceflight: An Example Using Bone Data from Rodents
Reynolds, R. J., Scott, R. T., Turner, R. T., Iwaniec, U. T., Bouxsein, M., Sanders, L., & Antonsen, E. (2022) · Biomedicines · doi:10.3390/biomedicines10092187 · Cited by 18

Authors: Textor, J., van der Zander, B., Gilthorpe, M. S., Liśkiewicz, M., & Ellison, G. T. H.
Affiliations: Radboud University Medical Center (NL)
University of Leeds (GB)
University of Lübeck (DE)
Corresponding author: Textor, Johannes
ORCID: Textor, Johannes
Gilthorpe, Mark S.
Liśkiewicz, Maciej
Ellison, George T.H.
Venue: International Journal of Epidemiology
Publisher: Oxford University Press (OUP)
Published: 2017-01-15
Volume: 45
Issue: 6
Pages: dyw341
ISSN: 0300-5771 (ISSN-L)
1464-3685
DOI: 10.1093/ije/dyw341
OpenAlex: W2576536258
Cited by: 2,295
References: 19
Citations by year: 2026: 156 · 2025: 409 · 2024: 451 · 2023: 392 · 2022: 323 · 2021: 256 · 2020: 201 · 2019: 74 · 2018: 22 · 2017: 6
FWCI: 35.46
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: International Journal of Epidemiology (publishedVersion)
PubMed (publishedVersion)
White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Topics: Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
Physical Sciences › Computer Science › Artificial Intelligence › Bayesian Modeling and Causal Inference
Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Keywords: directed acyclic graphs, causal inference, R package, adjustment sets, confounding
MeSH terms: Data Interpretation, Statistical, Epidemiologic Methods, Humans, Software, Bias, Causality, Confounding Factors, Epidemiologic

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Robust causal inference using directed acyclic graphs: the R package ‘dagitty’

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