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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Qu, Y., Lin, S., Bloom, M. S., Wang, X.-M., Ye, B., Nie, Z., Ou, Y., Mai, J., Wu, Y., Gao, X., et al. (2020) · Preventive Medicine · doi:10.1016/j.ypmed.2020.106319 · Cited by 13
Being Born in Winter–Spring and at Around the Time of an Influenza Pandemic Are Risk Factors for the Development of Schizophrenia: The Apna Study in Navarre, Spain
Álvarez-Mon, M. Á., Guillén-Aguinaga, S., Pereira-Sánchez, V., Onambele, L., Al-Rahamneh, M. J., Brugos‐Larumbe, A., Guillén‐Grima, F., & Ortuño, F. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10132859 · Cited by 13
“Using the Directed Acyclic Graphic (DAG) (Figure 1) [32], we studied the relation-”
Method
Association between heart rate-corrected QT interval and severe peripheral arterial disease in patients with type 2 diabetes and foot ulcers
Hong, J., Liu, W., Hu, X., Jiang, F.-F., Xu, Z., Li, F., Shen, F., & Zhu, H. (2021) · Endocrine Connections · doi:10.1530/ec-21-0140 · Cited by 13
Neighborhood-Based Socioeconomic Determinants of Cognitive Impairment in Zambian Children With HIV: A Quantitative Geographic Information Systems Approach
Buda, A. M., Dean, O. R., Adams, H., Mwanza-Kabaghe, S., Potchen, M. J., Mbewe, E. G., Kabundula, P., Mweemba, M., Matoka, B., Mathews, M., et al. (2021) · Journal of the Pediatric Infectious Diseases Society · doi:10.1093/jpids/piab076 · Cited by 13
Risk of bladder cancer death in patients younger than 50 with non-muscle-invasive and muscle-invasive bladder cancer
Russell, B. A., Liedberg, F., Hagberg, O., Ullén, A., Söderkvist, K., Ströck, V., Aljabery, F. A.-S., Gårdmark, T., Jerlström, T., Sherif, A. M., et al. (2021) · Scandinavian Journal of Urology · doi:10.1080/21681805.2021.2002399 · Cited by 15
“Adjustments were determined through the use of a directed acyclic graph using the DAGitty tool [13].”
Method
Prevalence and influencing factors of spinal cord injury-related osteoporosis and fragility fractures in Thai people with chronic spinal cord injury: A cross-sectional, observational study
Mahitthiharn, K., Kovindha, A., Kaewchur, T., Morse, L. R., & Pattanakuhar, S. (2022) · Journal of Spinal Cord Medicine · doi:10.1080/10790268.2022.2054763 · Cited by 13
Device-measured physical activity and cardiovascular disease risk in adolescent childhood cancer survivors. A physical activity in childhood cancer survivors (PACCS) study
Bratteteig, M., Anderssen, S. A., Rueegg, C. S., Ruud, E., Torsvik, I. K., Kriemler, S., & Grydeland, M. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.977365 · Cited by 13
Exposure to oestrogen and risk of anastomotic leakage after colorectal cancer surgery – A clue to the different leak rates in men and women
Rutegård, M., Moshtaghi‐Svensson, J., Weibull, C. E., Ottander, U., Nordenvall, C. A. M., & Sund, M. (2022) · Colorectal Disease · doi:10.1111/codi.16300 · Cited by 72
Road Traffic Noise, Obesity, and the Risk of Incident Type 2 Diabetes: A Cohort Study in UK Biobank
Zuo, L., Chen, X., Liu, M., Chen, L., Xu, W., Chen, H., Dong, S., Wei, Y., Li, L., Peng, S., et al. (2022) · International Journal of Public Health · doi:10.3389/ijph.2022.1605256 · Cited by 12
“A directed acyclic graph (DAG) graph (Supplementary Figure S1) was plotted to identify confounding factors [35].”
Pain severity at emergency department discharge as a predictor for chronification of pain
ten Doesschate, S. F. H., Kuijper, T. M., Koopman, S., Mol, S., Colen-Kroon, L., & Brown, V. V. (2022) · PAIN Reports · doi:10.1097/pr9.0000000000001048 · Cited by 13
“(DAG) was constructed.(28) The DAG was used to identify and include covariates in the multivariable regression analyses.”
Method
Meta-analysis of the normal diffusion tensor imaging values of the peripheral nerves in the upper limb
Wade, R. G., Lu, F., Poruslrani, Y., Karia, C. T., Feltbower, R. G., Plein, S., Bourke, G., & Teh, I. (2023) · Scientific Reports · doi:10.1038/s41598-023-31307-2 · Cited by 13
Maternal cortisol in 3rd trimester is associated with traits of neurodevelopmental disorder in offspring. Odense Child Cohort.
Andreasen, J. J., Tobiasen, B. B., Jensen, R. C., Boye, H., Jensen, T. K., Bilenberg, N., Andersen, M., & Glintborg, D. (2023) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2023.106293 · Cited by 13
Decreased Hip, Lower Leg, and Humeral Fractures but Increased Forearm Fractures in Highly Active Individuals
Stattin, K., Hållmarker, U., Ärnlöv, J., James, S. K., Michaëlsson, K., & Byberg, L. (2018) · Journal of Bone and Mineral Research · doi:10.1002/jbmr.3476 · Cited by 13
“Socioeconomic indicators and comorbidities were chosen as covariates using a directed acyclic graph-based method((35,36)) to control for confounding pathways involving healthy lifestyle habits (Supplemental Fig.”
Method
Finasteride Use and Risk of Male Breast Cancer: A Case–Control Study Using Individual-Level Registry Data from Denmark, Finland, and Sweden
Kjærulff, T. M., Ersbøll, A. K., Green, A., Emneus, M., Brasso, K., Iversen, P., Pukkala, E., Bolin, K., & Thygesen, L. C. (2019) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-18-0904 · Cited by 13
Impact of the onset of fixed appliance therapy on adolescents’ quality of life using a specific condition questionnaire: A cross-sectional comparison between male and female individuals
Corradi‐Dias, L., Paiva, S. M., Pretti, H., Pordeus, I. A., & Abreu, L. G. (2019) · Journal of Orthodontics · doi:10.1177/1465312519851220 · Cited by 13
Impact of Crop Diversity on Dietary Diversity Among Farmers in India During the COVID-19 Pandemic
Connors, K. M., Jaacks, L. M., Prabhakaran, P., Veluguri, D., Ramanjaneyulu, G. V., & Roy, A. (2021) · Frontiers in Sustainable Food Systems · doi:10.3389/fsufs.2021.695347 · Cited by 13
“The minimum adjustment set was determined using a Directed Acyclic Graph (Supplementary Figure 2) and DAGitty software (Textor et al., 2016).”
Method
Urinary phthalate metabolites and the risk of endometrial polyp: A pilot study from the TREE cohort
Zhang, M., Liu, C., Yuan, X.-Q., Yao, W., Yao, Q. Y., Huang, Y., Li, N., Deng, Y.-L., Chen, P., Yu, M., et al. (2022) · Environmental Pollution · doi:10.1016/j.envpol.2022.120711 · Cited by 13
Quantifying the effect of human population mobility on malaria risk in the Peruvian Amazon
Carrasco‐Escobar, G., Matta-Chuquisapon, J., Manrique, E., Ruiz-Cabrejos, J., Barboza, J. L., Wong, D., Henostroza, G., Llanos‐Cuentas, A., & Benmarhnia, T. (2022) · Royal Society Open Science · doi:10.1098/rsos.211611 · Cited by 14
“Fourth, although there were variables that could not be collected, these variables were identified as latent variables through the DAGs and their position as confounders in the causal path were examined.”
MethodInfluential
Impact of social deprivation on clinical outcomes of adults hospitalised with community-acquired pneumonia in England: a retrospective cohort study
Lawrence, H., McKeever, T. M., & Lim, W. S. (2022) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2022-001318 · Cited by 11
The Change in Social Eating over Time in People with Head and Neck Cancer Treated with Primary (Chemo)Radiotherapy: The Role of Swallowing, Oral Function, and Nutritional Status
Ninfa, A., Jansen, F., Fave, A. D., Lissenberg-Witte, B. I., Pizzorni, N., de Jong, R. J. B., Lamers, F., Leemans, C. R., Takes, R. P., Terhaard, C. H. J., et al. (2023) · Cancers · doi:10.3390/cancers15051603 · Cited by 12
“Figures were created using SPSS, Microsoft Excel (Microsoft Corporation, Redmond, WA, USA, 2018), and the R package “dagitty” [26].”
Method
Foreign-born status and risk of gestational diabetes mellitus by years of residence in the United States
Noah, A. I., Perez-Patron, M. J., Gongalla, M., Hill, A. V., & Taylor, B. D. (2023) · Scientific Reports · doi:10.1038/s41598-023-36789-8 · Cited by 12
Phthalate exposure in the neonatal intensive care unit is associated with development of bronchopulmonary dysplasia
Stroustrup, A., Zhang, X., Spear, E. A., Bandyopadhyay, S., Narasimhan, S., Meher, A. K., Choi, J., Gao, Q., Poindexter, B. B., Teitelbaum, S. L., et al. (2023) · Environment International · doi:10.1016/j.envint.2023.108117 · Cited by 12
“Model covariates were determined by a directed acyclic graph (DAG (Textor et al., 2016); Supplemental Fig.”
Method
Neighborhood Deprivation and Neural Tube Defects
Evans, S. P., Ailes, E. C., Kramer, M. R., Shumate, C., Reefhuis, J., Insaf, T. Z., Yazdy, M. M., Carmichael, S. L., Romitti, P. A., Feldkamp, M. L., et al. (2023) · Epidemiology · doi:10.1097/ede.0000000000001655 · Cited by 12
“We selected potential confounders using a directed acyclic graph (DAG) created via the program Daggity 26 (eFigure 1; http://links.lww.com/EDE/C56).”
Data‐driven lifestyle patterns and risk of dementia in older Australian women
Dingle, S. E., Bowe, S. J., Bujtor, M., Milte, C. M., Daly, R. M., Byles, J., Cavenagh, D., & Torres, S. J. (2023) · Alzheimer s & Dementia · doi:10.1002/alz.13467 · Cited by 11
Exploring Interactions Between Sex, Pain Characteristics, Disability, and Quality of Life in People With Chronic Spinal Pain: A Structural Equation Model
Bogaert, W. V., Liew, B. X. W., Fernández‐de‐las‐Peñas, C., Valera‐Calero, J. A., Varol, U., Coppieters, I., Kregel, J., Nijs, J., Meeus, M., Cagnie, B. J., et al. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.10.010 · Cited by 13
Associations between prenatal exposure to per- and polyfluoroalkyl substances and wheezing and asthma symptoms in 4-year-old children: The Japan Environment and Children's Study
Atagi, T., Hasegawa, K., Motoki, N., Inaba, Y., Toubou, H., Shibazaki, T., Nakayama, S. F., Kamijima, M., Tsukahara, T., & Nomiyama, T. (2023) · Environmental Research · doi:10.1016/j.envres.2023.117499 · Cited by 12
Causal Artificial Intelligence Models of Food Quality Data
Kurtanjek, Ž. (2024) · Food Technology and Biotechnology · doi:10.17113/ftb.62.01.24.8301 · Cited by 12
“The published version will differ from this one as a result of linguistic and technical corrections and layout editing. from corresponding d-separated (directionally separated subgraph) adjustments sets by ordinary least squares (OLS) regression with normalized data ( 17,33 ).”
Method
Statin therapy after elective abdominal aortic aneurysm repair improves long-term survival
Lilja, F., Wanhainen, A., & Mani, K. (2024) · British journal of surgery · doi:10.1093/bjs/znad383 · Cited by 12
“Previous knowledge and a directed acyclic graph (DAG) were utilized with R package Dagitty 11 to select suitable covariates for the propensity score matching ( Fig.”
Method
Muscle strength deficits are associated with low bone mineral density in young pediatric cancer survivors: The iBoneFIT project
Mármol-Pérez, A., Gil-Cosano, J. J., Ubago‐Guisado, E., Llorente‐Cantarero, F. J., Pascual-Gázquez, J. F., Ness, K. K., Martínez‐Vizcaíno, V., Ruiz, J. R., & Gracia‐Marco, L. (2024) · Journal of sport and health science/Journal of Sport and Health Science · doi:10.1016/j.jshs.2024.01.003 · Cited by 12
“42 (cid:1) 44 We used the online tool DAGitty 45 to construct a directed acyclic graph (DAG).”
Method
Fetal-origin cells in maternal circulation correlate with placental dysfunction, fetal sex, and severe hypertension during pregnancy
Fjeldstad, H. E., Jacobsen, D. P., Johnsen, G. M., Sugulle, M., Chae, A., Kanaan, S. B., Gammill, H. S., & Staff, A. C. (2024) · Journal of Reproductive Immunology · doi:10.1016/j.jri.2024.104206 · Cited by 12
Hypertensive disorders of pregnancy, neonatal outcomes and offspring developmental delay in Japan: The Tohoku Medical Megabank Project Birth and Three‐Generation Cohort Study
Chen, G., Ishikuro, M., Ohseto, H., Murakami, K., Noda, A., Shinoda, G., Orui, M., Obara, T., & Kuriyama, S. (2024) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.1111/aogs.14820 · Cited by 12
Causal diagramming for assessing human system risk in spaceflight
Antonsen, E., Reynolds, R. J., Charvat, J. M., Connell, E., Monti, A., Petersen, D., Nartey, N., Anton, W., Abukmail, A., Marotta, K., et al. (2024) · npj Microgravity · doi:10.1038/s41526-024-00375-7 · Cited by 12
“The ﬁ rst DAGs were drawn using Dagitty software 25 , which is freely available on the internet, and later, DAGvision software was implemented, which is still in development at NASA.”
Method
Association of race and ethnicity with the development of cystic fibrosis-related diabetes
Rayas, M. S., Mbogo, B., Kelly, A. T., Vu, P. T., Magaret, A., & Daley, T. C. (2024) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2024.07.018 · Cited by 14
Urinary metals and their associations with DNA oxidative damage among e-waste recycling workers in Hong Kong
Liao, G., Weng, X., Wang, F., Yu, Y. H. K., Arrandale, V. H., Chan, A. H. S., Lu, S., & Tse, L. A. (2024) · Ecotoxicology and Environmental Safety · doi:10.1016/j.ecoenv.2024.116872 · Cited by 12
Fish habitat models for a future of novel riverscapes
Hansen, H. H., Comoglio, C., Elings, J., Ericsson, P. S., Goethals, P. L. M., Gosselin, M., Hölker, F., Katopodis, C., Kemp, P. S., Lind, L. A., et al. (2024) · BioScience · doi:10.1093/biosci/biae081 · Cited by 12
“Uncovering the causal implications of impacts while untangling the errors associated with confounding can be addressed using the dagitty tool for graphical analysis of structural causal models (Textor et al. 2016 ).”
Method
Association between pertactin-producing Bordetella pertussis and fulminant pertussis in infants: a multicentre study in France, 2008–2019
Leroux, P., Matczak, S., Bouchez, V., Volant, S., Ouziel, A., Launay, E., Faye, A., Rabier, V., Sarlangue, J., Jeziorski, É., et al. (2024) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2024.09.009 · Cited by 12
Through the lens of causal inference: Decisions and pitfalls of covariate selection
Chen, G., Cai, Z., & Taylor, P. A. (2024) · Aperture Neuro · doi:10.52294/001c.124817 · Cited by 12
Socioeconomic disparities and risk of recurrent cardiovascular events and cardiovascular disease-free life expectancy in patients with established cardiovascular disease
Bijkerk, S., Visseren, F. L. J., van der Meer, M. G., de Borst, G. J., Ruigrok, Y. M., Jernberg, T., Woodward, M., van Charante, E. P. M., Vaartjes, I. C. H., Dorresteijn, J. A. N., et al. (2025) · European Journal of Preventive Cardiology · doi:10.1093/eurjpc/zwaf075 · Cited by 12
Effectiveness of bundle of care on tolerance of awake-prone positioning in patients with acute respiratory failure. A multicenter observational study
Olmos, M., Fuentes, N. A., Busico, M., Gallardo, A., Vitali, A., Costa, E. L. V., Amato, M. B. P., Bruhn, A. R., Esperatti, M., the Argentine Collaborative Group on High Flow, P. P., et al. (2025) · Intensive Care Medicine · doi:10.1007/s00134-025-07804-5 · Cited by 12
“Directed acyclic graphs (DAG) were used to identify and select variables potentially associated with both, bundle of care and study outcomes [29, 30] (electronic supplementary table 1 and figure 1).”
Variable selection for causal inference, prediction, and descriptive research: a narrative review of recommendations
Dyer, B. P. (2025) · European Heart Journal Open · doi:10.1093/ehjopen/oeaf070 · Cited by 12
Residential greenspace indicators and metabolic syndrome in the UK Biobank Cohort: mediation through behavioural, environmental, social and biomarker pathways
Odebeatu, C. C., Darssan, D., Roscoe, C., Reid, S. A., & Osborne, N. J. (2025) · Environmental Research · doi:10.1016/j.envres.2025.122148 · Cited by 12
Association of asthma severity and educational attainment at age 6–7 years in a birth cohort: population-based record-linkage study
Evans, A., Farewell, D. M., Demmler, J. C., Bandyopadhyay, A., Powell, C., & Paranjothy, S. (2020) · Thorax · doi:10.1136/thoraxjnl-2020-215422 · Cited by 12
“26 Models were adjusted for school factors 27 because of the known association with variability in educational attainment.”

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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