Cited by 1,036Statistical Methods in EpidemiologyHistorical and modern epidemiology studiesAdvanced Causal Inference Techniques

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PROPORTION OF DISEASE CAUSED OR PREVENTED BY A GIVEN EXPOSURE, TRAIT OR INTERVENTION1

MIETTINEN, OLLI S.·1974·American Journal of Epidemiology

DOI 10.1093/oxfordjournals.aje.a121617

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Abstract

The structures of two epidemiologic parameters are explored. One, the “etiologic fraction, ” relates to markers of increased risk, and it is the proportion of disease attributable to the marker and/or to factors associated with it. The other, the “prevented fraction, ” is the equivalent of this for a marker of reduced risk. It is shown that both parameters depend—in different ways—-on the frequency of the marker among cases of the disease, and on the “standardized morbidity ratio” for those with the marker. Point estimation of these parameters is often straight-forward, particularly in case-control studies.

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Determinants of Peripheral Arterial Disease in the Elderly
Meijer, W. T., Grobbee, D. E., Hunink, M. G. M., Albert Hofman, D., & Hoes, A. W. (2000) · Archives of Internal Medicine · doi:10.1001/archinte.160.19.2934 · Cited by 2
“where the relative risk (RR) is taken as the OR of the risk indicator resulting from the multiple logistic regression analyses, and the case fraction is the prevalence of the risk indicator in subjects with PAD.(29) Analyses were performed using commercially available software (BMDP Statistical Software, Inc, Los Ange…”
Method
Predictors of late development of heart failure in stable survivors of myocardial infarction
Lewis, E. F., Moyé, L. A., Rouleau, J. L., Sacks, F. M., Arnold, J. M. O., Warnica, J. W., Flaker, G. C., Braunwald, E., & Pfeffer, M. A. (2003) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(03)01057-x · Cited by 304
“The attributable risk of hypertension, diabetes, and exercise was calculated using the difference between the cumulative incidence rate of HF in the exposed group from the cumulative incidence rate of HF in the non-exposed group (12,13).”
Method
Adolescent suicidal behaviours in 32 low- and middle-income countries
McKinnon, B., Gariépy, G., Sentenac, M., & Elgar, F. J. (2016) · Bulletin of the World Health Organization · doi:10.2471/blt.15.163295 · Cited by 297
Update of mortality attributable to diabetes for the IDF Diabetes Atlas: Estimates for the year 2013
IDF Diabetes Atlas Group (2015) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2015.05.037 · Cited by 298
Intraosseous well-differentiated osteosarcoma
Unni, K. K., Dahlin, D. C., McLeod, R. A., & Pritchard, D. J. (1977) · Cancer · doi:10.1002/1097-0142(197709)40:3 · Cited by 180
Main traumatic events in Europe: PTSD in the European study of the epidemiology of mental disorders survey
Darves‐Bornoz, J., Alonso, J., de Girolamo, G., de Graaf, R., Haro, J. M., Kovess–Masféty, V., Lépine, J., Nachbaur, G., Nègre‐Pagès, L., Vilagut, G., et al. (2008) · Journal of Traumatic Stress · doi:10.1002/jts.20357 · Cited by 308
A heuristic approach to the formulas for population attributable fraction
Hanley, J. A. (2001) · Journal of Epidemiology & Community Health · doi:10.1136/jech.55.7.508 · Cited by 275
Distribution of Major Health Risks: Findings from the Global Burden of Disease Study
Rodgers, A., Ezzati, M., Hoorn, S. V., López, A. D., Lin, R., Murray, C. J. L., & Group Comparative Risk Assessment Collaborating (2004) · PLoS Medicine · doi:10.1371/journal.pmed.0010027 · Cited by 280
Respiratory Viral Detection in Children and Adults: Comparing Asymptomatic Controls and Patients With Community-Acquired Pneumonia
Self, W. H., Williams, D. J., Zhu, Y., Ampofo, K., Pavia, A. T., Chappell, J. D., Hymas, W. C., Stockmann, C. R., Bramley, A. M., Schneider, E., et al. (2015) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiv323 · Cited by 273
“An AF of 0.9 indicated that 90% of detections for that virus in patients with CAP were attributable to symptomatic illness, and 10% were due to asymptomatic shedding [23, [28] [29] [30] .”
BackgroundMethodInfluential
Nationwide survey of HTLV‐I–associated myelopathy in Japan: Association with blood transfusion
Osame, M., Janssen, R. S., Kubota, H., Nishitani, H., Igata, A., Nagataki, S., Mori, M., Goto, I., Shimabukuro, H., KHABBAZ, R. F., et al. (1990) · Annals of Neurology · doi:10.1002/ana.410280110 · Cited by 267
Dying for work: The magnitude of US mortality from selected causes of death associated with occupation
Steenland, K., Burnett, C. A., Lalich, N. R., Ward, E., & Hurrell, J. (2003) · American Journal of Industrial Medicine · doi:10.1002/ajim.10216 · Cited by 266
Prospective Study of Serum Selenium Levels and Incident Esophageal and Gastric Cancers
Mark, S. D. (2000) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/92.21.1753 · Cited by 267
Occupation and cancer in Britain
Rushton, L., Bagga, S., Bevan, R. J., Brown, T. P., Cherrie, J. W., Holmes, P., Fortunato, L., Slack, R. J., van Tongeren, M., Young, C., et al. (2010) · British Journal of Cancer · doi:10.1038/sj.bjc.6605637 · Cited by 273
Rural Industries Research and Development Corporation
Griffith, R., Ryan, P., Mitchell, M. S., Walkerden, G., Robinson, S., Brown, V. A., & Walker, B. (2011) · Cited by 265
Global Cardiovascular and Renal Outcomes of Reduced GFR
Thomas, B., Matsushita, K., Abate, K. H., Al-Aly, Z., Ärnlöv, J., Asayama, K., Atkins, R., Badawi, A. F., Ballew, S. H., Banerjee, A., et al. (2017) · Journal of the American Society of Nephrology · doi:10.1681/asn.2016050562 · Cited by 283
Respiratory syncytial virus infection during infancy and asthma during childhood in the USA (INSPIRE): a population-based, prospective birth cohort study
Rosas‐Salazar, C., Chirkova, T., Gebretsadik, T. S., Chappell, J. D., Peebles, R. S., Dupont, W. D., Jadhao, S. J., Gergen, P. J., Anderson, L. J., & Hartert, T. V. (2023) · The Lancet · doi:10.1016/s0140-6736(23)00811-5 · Cited by 271
Combined impact of healthy lifestyle factors on colorectal cancer: a large European cohort study
Aleksandrova, K., Pischon, T., Jenab, M., Bueno-de-Mesquita, H. B., Fedirko, V., Norat, T., Romaguera, D., Knüppel, S., Boutron‐Ruault, M., Dossus, L., et al. (2014) · BMC Medicine · doi:10.1186/s12916-014-0168-4 · Cited by 275
“PARs are calculated by reversing the coding of the protective factors and taking into account the relative proportion of exposed cases based on the formula from Miettinen et al .”
Aetiological role of common respiratory viruses in acute lower respiratory infections in children under five years: A systematic review and meta–analysis
Shi, T., McLean, K. A., Campbell, H. J., & Nair, H. (2015) · Journal of Global Health · doi:10.7189/jogh.05.010408 · Cited by 259
“Furthermore, strict interpretation would entail construal of negative values as indicative of the percentage of ALRI prevented by viral exposure [56] , which is biologically implausible.”
Background
Exogenous estrogen and endometrial carcinoma: Case-control and incidence study
McDonald, T. W., Annegers, J. F., O’Fallon, W. M., et al. (1977) · American Journal of Obstetrics and Gynecology · doi:10.1016/0002-9378(77)90351-9 · Cited by 245
Measuring the strength of associations between HLA antigens and diseases
BENGTSSON, B. O., & Thomson, G. J. (1981) · Tissue Antigens · doi:10.1111/j.1399-0039.1981.tb01404.x · Cited by 239
Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis
Li, X., Zhong, X., Wang, Y., Zeng, X., Luo, T., & Liu, Q. (2021) · PLOS ONE · doi:10.1371/journal.pone.0250602 · Cited by 236
“PAF 1⁄4 Pc� RR 1 RR where Pc is the prevalence of the risk factors in the population [10].”
Background
Role of tobacco smoking, chewing and alcohol drinking in the risk of oral cancer in Trivandrum, India: A nested case-control design using incident cancer cases
Muwonge, R., Ramadas, K., Sankila, R. J., Somanathan, T., Thomas, G., Vinoda, J., & Sankaranarayanan, R. (2008) · Oral Oncology · doi:10.1016/j.oraloncology.2007.06.002 · Cited by 232
Hepatocellular Carcinoma Risk Factors and Disease Burden in a European Cohort: A Nested Case-Control Study
Trichopoulos, D., Bamia, C., Λάγιου, Π., Fedirko, V., Trépo, E., Jenab, M., Pischon, T., Nöthlings, U., Overved, K., Tjønneland, A. M., et al. (2011) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djr395 · Cited by 233
“We used the formula suggested by Miettinen (23) and extended by Bruzzi et al.”
Method
Global survey of genetic variation in CCR5 , RANTES , and MIP-1 α: Impact on the epidemiology of the HIV-1 pandemic
Gonzalez, E., Dhanda, R., Bamshad, M., Mummidi, S., Geevarghese, R., Catano, G., Anderson, S. A., Walter, E. A., Stephan, K. T., Hammer, M. F., et al. (2001) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.091056898 · Cited by 225
Chronic disease burden associated with overweight and obesity in Ireland: the effects of a small BMI reduction at population level
Kearns, K., Dee, A., Fitzgerald, T., Doherty, E., & Perry, I. J. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-143 · Cited by 224
“To calculate the proportion of risk attributed to overweight and obesity, PAFs for the chronic diseases associated with overweight and obesity were calculated [17,18] using the ‘punaf ’ command in Stata.”
Method
Asthma cases attributable to atopy: Results from the Third National Health and Nutrition Examination Survey
Arbes, S. J., Gergen, P. J., Vaughn, B. J., & Zeldin, D. C. (2007) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2007.07.056 · Cited by 224
HCV burden of infection in Egypt: results from a nationwide survey
Guerra, J., Garenne, M., Mohamed, M. K., & Fontanet, A. L. (2012) · Journal of Viral Hepatitis · doi:10.1111/j.1365-2893.2011.01576.x · Cited by 214
Proportion of Community-Acquired Pneumonia Cases Attributable to Tobacco Smoking
Almirall, J., Gonzalez, C. A., Balanzó, X., & Bolíbar, I. (1999) · CHEST Journal · doi:10.1378/chest.116.2.375 · Cited by 208
Risk of disability and mortality due to overweight in a Finnish population.
Rissanen, A., Heliövaara, M., Knekt, P., Reunanen, A., Aromaa, A., & Maatela, J. (1990) · BMJ · doi:10.1136/bmj.301.6756.835 · Cited by 209
Obesity and underweight are associated with an increased risk of death after lung transplantation
Lederer, D. J., Wilt, J. S., D'Ovidio, F., Bacchetta, M. D., Shah, L., Ravichandran, S., Lenoir, J., Klein, B., Sonett, J. R., & Arcasoy, S. M. (2009) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200903-0425oc · Cited by 198
“Population attributable fractions were calculated using adjusted hazard ratios from Cox models (16).”
Method
Opportunities for Cost-effective Prevention of Late-Life Depression
Smit, F., Ederveen-Grochowska, A., Cuijpers, P. J., Deeg, D. J. H., & Beekman, A. T. F. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.3.290 · Cited by 200

Authors: MIETTINEN, O. S.
Corresponding author: MIETTINEN, OLLI S.
Venue: American Journal of Epidemiology
Publisher: Oxford University Press (OUP)
Published: 1974-05
Volume: 99
Issue: 5
Pages: 325-332
ISSN: 0002-9262 (ISSN-L)
1476-6256
DOI: 10.1093/oxfordjournals.aje.a121617
OpenAlex: W1953501928
Cited by: 1,036
References: 0
Citations by year: 2026: 24 · 2025: 34 · 2024: 41 · 2023: 35 · 2022: 26 · 2021: 35 · 2020: 39 · 2019: 40 · 2018: 31 · 2017: 22 · 2016: 27 · 2015: 25 · 2014: 28 · 2013: 22 · 2012: 26
FWCI: 7.80
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Epidemiology (publishedVersion)
PubMed (publishedVersion)
Topics: Physical Sciences › Mathematics › Statistics and Probability › Statistical Methods in Epidemiology
Health Sciences › Medicine › Epidemiology › Historical and modern epidemiology studies
Physical Sciences › Mathematics › Statistics and Probability › Advanced Causal Inference Techniques
Keywords: population attributable fraction, prevented fraction, attributable fraction, risk indicators, standardized morbidity ratio, case-control study, disease prevention
MeSH terms: Coffee, Coronary Disease, Drinking, Epidemiologic Methods, Humans, Hypercholesterolemia, Hypertension, Models, Theoretical, Morbidity, Myocardial Infarction, Population, Preventive Medicine, Smoking, Statistics as Topic

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PROPORTION OF DISEASE CAUSED OR PREVENTED BY A GIVEN EXPOSURE, TRAIT OR INTERVENTION1

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