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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Velloso, E., & Hornbæk, K. (2025) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3706598.3713789 · Cited by 11
“Nevertheless, DAGs support robust statistical methods, with packages in R (e.g. dagitty [69]) and python (e.g. DoWhy [60]) for drawing and analysing causal graphs.”
Are adults with chronic pain more likely to develop hypertension than adults without chronic pain? A systematic review and meta-analysis
Taylor, H. E., Salf, J. C., Roper-Marchand, C. R., Senaratne, D. N. S., Smith, B. H., Colvin, L., & George, J. (2025) · British Journal of Anaesthesia · doi:10.1016/j.bja.2025.06.006 · Cited by 9
Clinicians’ Perceived Understanding of Biostatistical Results in the Medical Literature: A Cross-Sectional Study
Ganasegeran, K., Ch’ng, A. S. H., Jamil, M. F. A., & Looi, I. (2019) · Medicina · doi:10.3390/medicina55060227 · Cited by 9
Night work, chronotype and cortisol at awakening in female hospital employees
Burek, K., Rabstein, S., Kantermann, T., Vetter, C., Rotter, M., Wang‐Sattler, R., Lehnert, M., Pallapies, D., Jöckel, K., Brüning, T., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-10054-w · Cited by 11
Timing of Breeding Reveals a Trade-Off between Immune Investment and Life History in Tree Swallows
van Oordt, D. C., Taff, C. C., Ryan, T. A., & Vitousek, M. N. (2022) · Integrative and Comparative Biology · doi:10.1093/icb/icac033 · Cited by 9
Major depressive disorders increase the susceptibility to self-reported infections in two German cohort studies
Elpers, H., Teismann, H., Wellmann, J., Berger, K., Karch, A., & Rübsamen, N. (2022) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-022-02328-5 · Cited by 9
“de/ruebsame/mdd_infection_germany_bidirect_habids) [17], we identified the following minimal sufficient adjustment set (MSAS): age, sex, socioeconomic status, body mass index (BMI), household size, smoking, alcohol intake, physical activity, nutritional status, stress, intake of proton pump inhibitors, asthma bronchia…”
Background
Effectiveness of a care bundle for primary prevention of intraventricular hemorrhage in high-risk neonates: a Bayesian analysis
al-Haddad, B. J. S., Bergam, B., Johnson, A., Kolnik, S. E., Thompson, T., Perez, K., Kennedy, J., Enquobahrie, D. A., Juul, S. E., & German, K. R. (2022) · Journal of Perinatology · doi:10.1038/s41372-022-01545-9 · Cited by 9
“Dagitty graph theory software was used to determine the minimal adjustment set [8].”
Method
Association of residential and school green- and bluespace with academic performance in 10-13-year-old Polish schoolchildren with and without attention deficit hyperactivity disorder
Singh, N., Baumbach, C., Buczyłowska, D., Bratkowski, J., Mysak, Y., Wierzba-Łukaszyk, M., Sitnik‐Warchulska, K., Skotak, K., Lipowska, M., Izydorczyk, B., et al. (2022) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2022.160123 · Cited by 9
The impact of aspirin exposure prior to intensive care unit admission on the outcomes for patients with sepsis-associated acute respiratory failure
Lu, Z., Fang, P., Xia, D., Li, M., Li, S.-R., Wang, Y., Fu, L., Sun, G., & You, Q. (2023) · Frontiers in Pharmacology · doi:10.3389/fphar.2023.1125611 · Cited by 9
“For this reason, it has been frequently used to identify suitable sets of covariates in causal effects estimation (Textor et al., 2016; Fang and Zhang, 2022).”
Method
Key predictors of psychological distress and wellbeing in Australian frontline healthcare workers during COVID-19 (Omicron wave)
Lee, B. E. C., Ling, M., Boyd, L., Olsson, C. A., & Sheen, J. A. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1200839 · Cited by 9
“To identify MSAS for each predicter, directed acyclic graphs (DAG) were developed (Rohrer, 2018), using DAGitty1 (Textor et al., 2016).”
Method
Auditory complications among childhood cancer survivors and health-related quality of life: a PanCareLIFE study
Strebel, S., Baust, K., Grabow, D., Byrne, J., ten Langer, T. S., Zehnhoff‐Dinnesen, A. A., Kuonen, R., Weiß, A., Kepák, T., Kruseová, J., et al. (2023) · Journal of Cancer Survivorship · doi:10.1007/s11764-023-01456-4 · Cited by 9
“S1) [30, 31], we adjusted our models for the following co-variables: age at survey (continuous in years); age at cancer diagnosis (continuous in years); type of cancer (categorical according ICCC-3); history of relapse (yes, no); surgery (yes, no); chemotherapy (yes, no); radiotherapy (yes, no);…”
The intensity and duration of occupational noise exposure and cardiovascular disease in the United States: a nationally representative study, 2015 to 2020
Guo, X., Davies, H., & Karim, M. E. (2023) · Annals of Work Exposures and Health · doi:10.1093/annweh/wxad065 · Cited by 9
Benzene exposure and risk of lung cancer in the Norwegian Offshore Petroleum Worker cohort: a prospective case-cohort study
Babigumira, R., Veierød, M. B., Hosgood, H. D., Samuelsen, S. O., Bråtveit, M., Kirkeleit, J., Rothman, N., Qing Lan, B., Silverman, D. T., Friesen, M. C., et al. (2023) · Occupational and Environmental Medicine · doi:10.1136/oemed-2023-109139 · Cited by 9
“25 We used directed acyclic graphs (DAGs) 26 to arrive at three models.”
Method
Risk of subsequent gliomas and meningiomas among 69,460 5-year survivors of childhood and adolescent cancer in Europe: the PanCareSurFup study
Heymer, E. J., Hawkins, M. M., Winter, D., Teepen, J. C., Sunguc, C., Ronckers, C. M., Allodji, R. S., Alessi, D., Sugden, E. M., Belle, F. N., et al. (2024) · British Journal of Cancer · doi:10.1038/s41416-024-02577-y · Cited by 9
“Directed acyclic graphs [21] and evidence from current literature [22] were used to guide the choice of potential set of confounders to include in each Poisson regression model.”
Method
Education and pandemic SARS-CoV-2 infections in the German working population – the mediating role of working from home
Wachtler, B., Beese, F., Demirer, I., Haller, S., Pförtner, T., Wahrendorf, M., Grabka, M. M., & Hoebel, J. (2024) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.4144 · Cited by 9
Misstatements, misperceptions, and mistakes in controlling for covariates in observational research
Yu, X. D., Zoh, R. S., Fluharty, D. A., Mestre, L. M., Valdez, D., Tekwe, C. D., Vorland, C. J., Jamshidi‐Naeini, Y., Chiou, S. H., Lartey, S. T., et al. (2024) · eLife · doi:10.7554/elife.82268 · Cited by 10
“The freely available web application dagitty (https://www.dagitty.net/) allows users to specify their DAGs and the application provides the set of controlling variables ( Textor et al., 2016 ).”
Method
High anaemia and iron deficiency prevalence among pregnant women living in low groundwater iron areas of Bangladesh
Hasan, M. I., Ahmed, S., McLean, A. R. D., Rahman, A. M. Q., Bhuiyan, M. S. A., Tipu, S. M. M. U., Braat, S., Arifeen, S. E., Hamadani, J. D., Pasricha, S., et al. (2024) · BMC Public Health · doi:10.1186/s12889-024-20480-2 · Cited by 9
“Data were analyzed using STATA Version 17.0 (Stata-Corp, Statistical Software: College Station, TX) and DAGitty Version 3.0 was used to draw a directed acyclic graph to guide the adjustment set in our multivariable analyses [18].”
MethodInfluential
Identifiability and Estimation Under the Test-negative Design With Population Controls With the Goal of Identifying Risk and Preventive Factors for SARS-CoV-2 Infection
Schnitzer, M. E., Harel, D., Ho, V., Koushik, A., & Merckx, J. (2021) · Epidemiology · doi:10.1097/ede.0000000000001385 · Cited by 9
Using Bayesian networks to clarify interpretation of exposure–response regression coefficients: blood lead–mortality association as an example
Cox, L. A. (2020) · Critical Reviews in Toxicology · doi:10.1080/10408444.2020.1787329 · Cited by 9
“Graph-theoretic algorithms can be applied to a BN’s structure to automatically identify minimal sufficient adjustment sets for estimating both (a) the direct effect of one variable on another, holding the levels of all other variables fixed at specified levels; and (b) the total effect of one variable on another, allo…”
BackgroundMethodInfluential
Reduced masticatory function predicts gastroesophageal reflux disease and esophageal dysphagia in patients referred for upper endoscopy: A cross-sectional study
Pauletti, R. N., Callegari-Jacques, S. M., Fornari, L., de Moraes, J. I., & Fornari, F. (2021) · Digestive and Liver Disease · doi:10.1016/j.dld.2021.09.016 · Cited by 9
Statistical adjustments of environmental pollutants arising from multiple sources in epidemiologic studies: The role of markers of complex mixtures
Goldberg, M. S., Baumgartner, J. C., & Chevrier, J. (2021) · Atmospheric Environment · doi:10.1016/j.atmosenv.2021.118788 · Cited by 9
Long‐term oncological outcomes in patients undergoing laparoscopic versus open surgery for colon cancer: A nationwide cohort study
Vogelsang, R. P., Fransgaard, T., Klein, M. F., & Gögenür, I. (2021) · Colorectal Disease · doi:10.1111/codi.16022 · Cited by 9
Tumour genotypes account for survival differences in right‐ and left‐sided colon cancers
Ward, T. M., Cauley, C. E., Stafford, C. E., Goldstone, R. N., Bordeianou, L., Kunitake, H., Berger, D. L., & Ricciardi, R. (2022) · Colorectal Disease · doi:10.1111/codi.16060 · Cited by 9
“We used a directed acyclic graph (DAG) to design and interpret our regression models for causal inference [22].”
Method
Te Ara Mua – Future Streets: Can a streetscape upgrade designed to increase active travel change residents’ perceptions of neighbourhood safety?
Witten, K., Macmillan, A. K., Mackie, H. W., van der Werf, B., Smith, M., Field, A., Woodward, A. J., & Hosking, J. (2022) · Wellbeing Space and Society · doi:10.1016/j.wss.2022.100079 · Cited by 9
Environmental factors associated with the time to tuberculosis diagnosis in prisoners in São Paulo, Brazil
Pelissari, D. M., Saita, N. M., Monroe, A. A., & Díaz-Quijano, F. A. (2022) · American Journal of Infection Control · doi:10.1016/j.ajic.2022.05.015 · Cited by 9
CpG methylation patterns in placenta and neonatal blood are differentially associated with neonatal inflammation
Eaves, L. A., Enggasser, A. E., Camerota, M., Gogcu, S., Gower, W. A., Hartwell, H. J., Jackson, W., Jensen, E. T., Joseph, R. M., Marsit, C. J., et al. (2022) · Pediatric Research · doi:10.1038/s41390-022-02150-4 · Cited by 12
Livestock, pathogens, vectors, and their environment: A causal inference-based approach to estimating the pathway-specific effect of livestock on human African trypanosomiasis risk
Meisner, J., Kato, A. B., Lemerani, M., Miaka, E. M., Taban, A. I., Wakefield, J. C., Rowhani‐Rahbar, A., Pigott, D. M., Mayer, J. D., & Rabinowitz, P. M. (2022) · PLOS Global Public Health · doi:10.1371/journal.pntd.0010155 · Cited by 14
“net [23] to identify the minimally sufficient adjustment set.”
Background
Arsenic exposure and respiratory outcomes during childhood in the INMA study
Signes‐Pastor, A. J., Coto, S. D., Martínez‐Camblor, P., Carey, M. P., Soler-Blasco, R., García‐Villarino, M., Fernández‐Somoano, A., Júlvez, J., Carrasco, P., Lertxundi, A., et al. (2022) · PLoS ONE · doi:10.1371/journal.pone.0274215 · Cited by 11
“The covariates were selected based on previous studies and the Directed Acyclic Graph using the DAGitty software (S1 Fig—Directed acyclic graph or causal Bayesian network created using DAGitty browser-based environment) [9, 57, 58].”
Method
Prenatal exposure to multiple metallic and metalloid trace elements and the risk of bacterial sepsis in extremely low gestational age newborns: A prospective cohort study
Bulka, C. M., Eaves, L. A., Gardner, A. J., Parsons, P. J., Galusha, A. L., Roell, K. R., Smeester, L., O’Shea, T. M., & Fry, R. C. (2022) · Frontiers in Epidemiology · doi:10.3389/fepid.2022.958389 · Cited by 9
“We narrowed these down by using a directed acyclic graph (DAG) to identify variables associated with both metal/metalloid exposures and sepsis, excluding any that could be causal intermediates (Supplementary Figure 1) (30).”
Loss of Function ABCG2 c.421C>A (rs2231142) Polymorphism Increases Steady-State Exposure to Mycophenolic Acid in Stable Renal Transplant Recipients: An Exploratory Matched Cohort Study
Borić-Bilušić, A. A., Božina, N., Lalić, Z., Lovrić, M., Škegro, S. N., Penezić, L., Barišić, K., & Trkulja, V. (2022) · Advances in Therapy · doi:10.1007/s12325-022-02378-w · Cited by 10
“We followed the principles introduced by Pearl [15] with operational development [16, 17] and implementation carried out in the daggity [18] package in R [19] [see Electronic supplementary material (ESM)—Supplementary Methods A, for details].”
Method
Early origins of metabolic and overall health in young adults: An outcome-wide analysis in a general cohort population
Amadou, C., Heude, B., de Lauzon‐Guillain, B., Lioret, S., Descarpentrie, A., Ribet, C., Zins, M., & Charles, M.-A. A. (2022) · Diabetes & Metabolism · doi:10.1016/j.diabet.2022.101414 · Cited by 11
Exploring the Lifetime Effect of Children on Wellbeing Using Two-Sample Mendelian Randomisation
Woolf, B. A. R., Sallis, H., & Munafo, M. R. (2023) · Genes · doi:10.3390/genes14030716 · Cited by 7
Children in Denmark with cerebral palsy rarely complete elementary school
Pedersen, S. V., Wiingreen, R., Hansen, B. M., Greisen, G. O., Larsen, M. L., & Hoei‐Hansen, C. E. (2023) · Developmental Medicine & Child Neurology · doi:10.1111/dmcn.15589 · Cited by 9
Forgotten but not gone in rural South Africa: Urinary schistosomiasis and implications for chronic kidney disease screening in endemic countries
Craik, A., Gondwe, M. S., Mayindi, N. B., Chipungu, S., Khoza, B. L., Gómez-Olivé, F. X., Tollman, S. M., Frean, J., Tomlinson, L. A., & Fabian, J. (2023) · Wellcome Open Research · doi:10.12688/wellcomeopenres.18650.3 · Cited by 9
“Additional confounders to be entered into the fully adjusted logistic regression model were determined using a directional acyclic graph 22 .”
Integrated and diurnal indices of maternal pregnancy cortisol in relation to sex‐specific parasympathetic responsivity to stress in infants
Cowell, W., Khoury, J. E., Petty, C. R., Day, H., Benítez, B. E., Cunningham, M. K., Schulz, S. M., Ritz, T., Wright, R. J., & Enlow, M. B. (2020) · Developmental Psychobiology · doi:10.1002/dev.22015 · Cited by 10
Etiology-specific variation in survival following non-traumatic spinal cord injury: a causal inference approach using data from a population-based cohort
Buzzell, A., Chamberlain, J. D., Hoogland, I. E., Jordan, X., Schubert, M. J. W., Zwahlen, M., & Brinkhof, M. W. G. (2020) · Spinal Cord · doi:10.1038/s41393-020-00554-9 · Cited by 9
“The R package dagitty implements the DAGitty web application and was used to evaluate the DAG-dataset consistency [23].”
BackgroundMethod
Operative approach influences functional outcome after DAIR for infected total hip arthroplasty
Pollmann, C. T., Gjertsen, J., Dale, H., Straume-Næsheim, T. M., Dybvik, E., & Hallan, G. (2020) · The Bone & Joint Journal · doi:10.1302/0301-620x.102b12.bjj-2020-0501.r1 · Cited by 9
““Do not know” 25 (29) 17 (17) -12 (-24 to 0)”
A Dietary Inflammatory Index and associations with C-reactive protein in a general adult population
Hart, M. J., Torres, S. J., McNaughton, S. A., & Milte, C. M. (2021) · European Journal of Nutrition · doi:10.1007/s00394-021-02573-5 · Cited by 9
“The DAG was constructed using the online tool DAGitty [29].”
Method
Farmer Decision-Making on the Concept of Coexistence: A Comparative Analysis between Organic and Biotech Farmers in the Philippines
Gonzalvo, C. M., Aala, W., & Maharjan, K. L. (2021) · Agriculture · doi:10.3390/agriculture11090857 · Cited by 18
Household transmission of SARS-CoV-2 from humans to pets in Washington and Idaho: burden and risk factorsPreprint
Meisner, J., Baszler, T. V., Kuehl, K. H., Ramirez, V., Baines, A., Frisbie, L. A., Lofgren, E., DeAvila, D. M., Wolking, R. M., Bradway, D. S., et al. (2021) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2021.04.24.440952 · Cited by 9
Impact of episodic and chronic vestibular disorders on health-related quality of life and functioning—results from the DizzyReg patient registry
Strobl, R., Harajli, S., Huppert, D., Zwergal, A., & Grill, E. (2023) · Quality of Life Research · doi:10.1007/s11136-023-03345-w · Cited by 8
“DAGs helped identifying potential collider bias and to avoid an over-specified model by proposing a minimal sufficient adjustment set [30, 31].”
Method
Bias in the measurement of the outcome is associated with effect sizes in randomized clinical trials on exercise therapy for chronic low back pain: a meta-epidemiological study
Innocenti, T., Hayden, J. A., Salvioli, S., Giagio, S., Piano, L., Cosentino, C., Brindisino, F., Feller, D., Ogilvie, R., Gianola, S., et al. (2023) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2023.09.001 · Cited by 8
Association between using a prehospital assessment unit and hospital admission and mortality: a matched cohort study
Wolthers, S. A., Blomberg, S. N. F., Breindahl, N., Anjum, S., Hägi‐Pedersen, D., Ersbøll, A. K., Andersen, L. B., & Christensen, H. C. (2023) · BMJ Open · doi:10.1136/bmjopen-2023-075592 · Cited by 8
Prenatal Metal Exposure Alters the Placental Proteome in a Sex-Dependent Manner in Extremely Low Gestational Age Newborns: Links to Gestational Age
Freedman, A. N., Roell, K. R., Engwall, E., Bulka, C. M., Kuban, K., Herring, L. E., Mills, C. A., Parsons, P. J., Galusha, A. L., O’Shea, T. M., et al. (2023) · International Journal of Molecular Sciences · doi:10.3390/ijms241914977 · Cited by 8
“For all models, covariates were selected a priori based on a directed acyclic graph approach [74].”
Method

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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