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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Background
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Method
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Background
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“000 White 2,846 (65) 2,814 (64) 3,455 (60) Hispanic 525 (19) 835 (19) 1,177 (21) African American 525 (12) 548 (13) 825 (14) Other 175 (4) 184 (4) 293 (5) Maternal education more than high school graduate 4,094 (93) 3,942 (90) 5,181 (90) .”
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Background
A pilot study of the effect of exposure to child abuse or neglect on adolescent suicidal behavior
Deykin, E. Y., Alpert, J. J., & Mcnamarra, J. J. (1985) · American Journal of Psychiatry · doi:10.1176/ajp.142.11.1299 · Cited by 103
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Method
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Greenland, S. (1984) · Statistics in Medicine · doi:10.1002/sim.4780030206 · Cited by 99
Acute thrombocytopenic purpura in relation to the use of drugs
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Method
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GENETICS OF HLA DISEASE ASSOCIATION
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“where Px is the proportion of exposure in the population (4, 34).”
Background
Physical Workload and Ergonomic Factors Associated With Prevalence of Back and Neck Pain in Urban Transit Operators
Krause, N., Ragland, D. R., Greiner, B. A., et al. (1997) · Spine · doi:10.1097/00007632-199709150-00010 · Cited by 93
Impact of work environment on cardiovascular diseases in Denmark.
Olsen, O., & Kristensen, T. S. (1991) · Journal of Epidemiology & Community Health · doi:10.1136/jech.45.1.4 · Cited by 93
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“The population-attributable fraction (PAF) is the percentage of a disease in a population that is due to a specific risk factor (24).”
Background
Protective effect of BCG vaccination in infant Asians: a case-control study.
Packe, G. E., & Innes, J. A. (1988) · Archives of Disease in Childhood · doi:10.1136/adc.63.3.277 · Cited by 88
Increased risk of pertussis in patients with asthma
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“Population attributable proportions were calculated as pc*(RR-1)/RR where pc is the proportion exposed to an HPV type among cases and RR is the type-specific relative rate adjusted for infection with other HPV types and censoring before or after 6 months of follow-up (Miettinen, 1974).”
Method
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Miranda, M. B., Lauseker, M., Kraus, M.-P., et al. (2016) · Leukemia · doi:10.1038/leu.2016.20 · Cited by 87
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“Extreme contrast risk ratios (relative risk or RRs) comparing the maximum (three or more) versus minimum (zero, one, or two) combinations of LRLBs from the most adjusted model were used in the pairwise meta-analysis.”
MethodInfluential
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Serologic Therapy of Tetanus in the United States, 1965-1971
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Alcohol dehydrogenase and aldehyde dehydrogenase genotypes and alcoholism among Taiwanese aborigines
Chen, W. J., Loh, E. W., Hsu, Y. P., & Cheng, A. T. A. (1997) · Biological Psychiatry · doi:10.1016/s0006-3223(96)00072-8 · Cited by 80
“…the proportion of the potential total load of the disease that is prevented by the protective allele of the alcohol metabolism genes, was computed as {]j[(l ~/I.)RR + J;.l } (1 -RR), where f is the fraction of cases with the protective factor and RR is the measure of relative risk (Miettinen 1974).”
Perceived family history of problem gambling and scores on SOGS
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Meta-analysis and functional effects of the SLC30A8 rs13266634 polymorphism on isolated human pancreatic islets
Cauchi, S., Guerra, S. D., Choquet, H., D’Aleo, V., Groves, C. J., Lupi, R., McCarthy, M. I., Froguel, P., & Marchetti, P. (2010) · Molecular Genetics and Metabolism · doi:10.1016/j.ymgme.2010.01.001 · Cited by 82
Severe Housing Insecurity during Pregnancy: Association with Adverse Birth and Infant Outcomes
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“We then estimated the population attributable fraction (PAF) using the formula derived by Miettinen [30] and r commended by Rockhill to produce internally valid estimates of PAF when confounding exists [31].”
Method
Patterns of aspirin use in middle-aged adults: The atherosclerosis risk in communities (ARIC) study
Shahar, E., Folsom, A. R., Romm, F. J., Bisgard, K. M., Metcalf, P., Crum, L. D., McGovern, P. G., Hutchinson, R. G., & HEISS, G. M. (1996) · American Heart Journal · doi:10.1016/s0002-8703(96)90173-8 · Cited by 82
The Burden of Dementia due to Down Syndrome, Parkinson’s Disease, Stroke, and Traumatic Brain Injury: A Systematic Analysis for the Global Burden of Disease Study 2019
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“They were calculated using the formula below [27]: PAF = prevalence × RR − 1 prevalence × RR − 1 + 1 .”
Method
A Comparison of Insomnia and Depression as Predictors of Disability Pension: The HUNT Study
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Statistical Methods in the Global Enteric Multicenter Study (GEMS)
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“AF can be estimated equivalently [16] from the distribution of the exposure (risk factor) either in the entire population [17] or in cases of disease [18].”
Background
Body Mass Index, Body Height, and Subsequent Risk of Colorectal Cancer in Middle-Aged and Elderly Japanese Men and Women: Japan Public Health Center-Based Prospective Study
Otani, T., Iwasaki, M., & Inoue, M. (2005) · Cancer Causes & Control · doi:10.1007/s10552-005-4573-z · Cited by 77
“The population-attributable fraction (PAF) was esti mated by Pe (RRa - l)/RRa, where Pe was the preva lence of exposure among incident cases and RRa was the adjusted RR [45].”
Method
Epidemiology of Cutaneous Leishmaniasis in Colombia: Environmental and Behavioral Risk Factors for Infection, Clinical Manifestations, and Pathogenicity
Weigle, K. A., Santrich, C., Martinez, F., Valderrama, L., & Saravia, N. G. (1993) · The Journal of Infectious Diseases · doi:10.1093/infdis/168.3.709 · Cited by 77
“The population attributable risks (AR) were estimated: AR = (OR ? 1 )Ce70R, where Ce ^ proportion of cases exposed to the risk factor [20].”
Background
Effectiveness of the MF59-adjuvanted influenza vaccine in preventing emergency admissions for pneumonia in the elderly over 64 years of age
Puig‐Barberà, J., Díez‐Domingo, J., Pérez‐Hoyos, S., Belenguer‐Varea, Á., & Vidal, D. G. (2004) · Vaccine · doi:10.1016/j.vaccine.2004.07.017 · Cited by 79
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Gersten, J. C., Beals, J., & Kallgren, C. A. (1991) · American Journal of Community Psychology · doi:10.1007/bf00937988 · Cited by 79
Attributable fractions: fundamental concepts and their visualization
Eide, G. E., & Heuch, I. (2001) · Statistical Methods in Medical Research · doi:10.1177/096228020101000302 · Cited by 83
INCORPORATING VARIABILITY IN ESTIMATES OF HETEROGENEITY IN THE RANDOM EFFECTS MODEL IN META-ANALYSIS
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Airflow obstruction attributable to work in industry and occupation among U.S. race/ethnic groups: A study of NHANES III data
Hnizdo, E., Sullivan, P. A., Bang, K. M., & Wagner, G. R. (2004) · American Journal of Industrial Medicine · doi:10.1002/ajim.20042 · Cited by 76
An Epidemiological Approach to Depression Prevention in Old Age
Smits, F., Smits, N., Schoevers, R. A., Deeg, D. J. H., Beekman, A. T. F., & Cuijpers, P. J. (2008) · American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e3181662ab6 · Cited by 74
“When converted into a percentage, the AF denotes by how many percent points the current incidence rate of depression in the population would be reduced if the adverse effect of the risk indicator is completely blocked.(38,39) This equals the maximum possible impact of a completely successful preventive intervention.”
Background
Update of mortality attributable to diabetes for the IDF Diabetes Atlas: Estimates for the year 2011
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Factor H, a regulator of complement activity, is a major determinant of meningococcal disease susceptibility in UK Caucasian patients
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“The population attributable fraction (PAF), an estimate of the likely population effect of a polymorphism on disease susceptibility was calculated as previously described [18].”
Method
Identification and Relative Weight of Cardiovascular Risk Factors
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Familial and Attributable Risks in Cutaneous Melanoma: Effects of Proband and Age
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Family History Is a Risk Factor for COPD
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The C677T mutation of the 5,10-methylenetetrahydrofolate reductase gene is a moderate risk factor for spina bifida in Italy.
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POLYGENIC AND MULTIFACTORIAL DISEASE GENE ASSOCIATION IN MAN: Lessons from AIDS
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Puig‐Barberà, J., Márquez-Calderón, S., Masoliver-Fores, A., Lloria-Paes, F., Ortega-Dicha, A., Gil-Martín, M., & Calero-Martinez, M. J. (1997) · Journal of Epidemiology & Community Health · doi:10.1136/jech.51.5.526 · Cited by 74
Principles of nonexperimental assessment of excess risk, with special reference to adverse drug reactions
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Self-citation
Does Anxiety Increase the Risk of all-Cause Dementia? An Updated Meta-Analysis of Prospective Cohort Studies
Santabárbara, J., Lipnicki, D. M., Olaya, B., Villagrasa, B., Bueno‐Notivol, J., Nuez, L., López‐Antón, R., & Gracia‐García, P. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9061791 · Cited by 81
Selecting key variables for depression prevention: results from a population-based prospective epidemiological study
Smit, F., Beekman, A. T. F., Cuijpers, P. J., de Graaf, R., & Vollebergh, W. (2003) · Journal of Affective Disorders · doi:10.1016/j.jad.2003.08.007 · Cited by 71
Correlates of Recurrent Wheezing in School-Age Children. The Physicians of Raleigh Pediatric Associates
Henderson, F. W., Henry, M. M., Ivins, S. S., Morris, R., Neebe, E. C., Leu, S. Y., & Stewart, P. W. (1995) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.151.6.7767521 · Cited by 71
Estimation and application of population attributable fraction in ecological studies
Lin, C.-K., & Chen, S. (2019) · Environmental Health · doi:10.1186/s12940-019-0492-4 · Cited by 72
A case-control study to evaluate the effectiveness of mass neonatal BCG vaccination among Canadian Indians.
Young, T. K., & Hershfield, E. S. (1986) · American Journal of Public Health · doi:10.2105/ajph.76.7.783 · Cited by 71
Increased risk for transverse digital deficiency after chorionic villus sampling: Results of the United States multistate case‐control study, 1988–1992
Olney, R. S., Khoury, M. J., Alo, C. J., et al. (1995) · Teratology · doi:10.1002/tera.1420510104 · Cited by 71
Combined effect of silica dust exposure and tobacco smoking on the prevalence of respiratory impairments among gold miners.
Hnizdo, E., Baskind, E., & Sluis-Cremer, G. K. (1990) · Scandinavian Journal of Work Environment & Health · doi:10.5271/sjweh.1768 · Cited by 71
Risk of agranulocytosis and aplastic anaemia in relation to use of antithyroid drugs. International Agranulocytosis and Aplastic Anaemia Study.
(1988) · BMJ · doi:10.1136/bmj.297.6643.262 · Cited by 70
Proportion of lung cancers due to occupational exposure
Pastorino, U., Berrino, F., Gervasio, A., et al. (1984) · International Journal of Cancer · doi:10.1002/ijc.2910330211 · Cited by 71
RE: "CONFIDENCE LIMITS MADE EASY: INTERVAL ESTIMATION USING A SUBSTITUTION METHOD"
Greenland, S. (1999) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a009905 · Cited by 71
Update of the fractions of cardiovascular diseases and mental disorders attributable to psychosocial work factors in Europe
Niedhammer, I., Sultan‐Taïeb, H., Parent-Thirion, A., & Chastang, J. (2021) · International Archives of Occupational and Environmental Health · doi:10.1007/s00420-021-01737-4 · Cited by 70
“The maximum value was calculated from Miettinen’s formula (Miettinen 1974), that ensures that the overall AF does not exceed 100% (contrary to the mere sum of the individual AFs for each exposure) and assumes the independence (i.e. no overlap) between p exposures: All statistical analyses were…”
Method
Non‐Latin European descent could be a requirement for association of NTDs andMTHFRvariant 677C > T: A meta‐analysis
Amorim, M. R., Lima, M. A. C., Castilla, E. E., et al. (2007) · American Journal of Medical Genetics Part A · doi:10.1002/ajmg.a.31812 · Cited by 70
Evaluation of a methylenetetrahydrofolate-dehydrogenase 1958G>A polymorphism for neural tube defect risk
Marco, P. D., Merello, E., Calevo, M. G., Mascelli, S., Raso, A., Cama, A., & Capra, V. (2005) · Journal of Human Genetics · doi:10.1007/s10038-005-0329-6 · Cited by 70
Hepatitis B and C viruses in the etiology of hepatocellular carcinoma; a study in Greece using third-generation assays
Kuper, H., Τζώνου, Α., Kaklamani, E., Hadziyannis, S. J., Tasopoulos, N., Λάγιου, Π., Trichopoulos, D., & Stuver, S. O. (2000) · Cancer Causes & Control · doi:10.1023/a:1008951901148 · Cited by 69
“where p is the proportion of exposed among all cases and OR is the adjusted OR comparing HCC cases to the combined control series [17].”
Result
Association of Mucosal Leishmaniasis with HLA
Petzl‐Erler, M. L., Belich, M. P., & Queiroz‐Telles, F. (1991) · Human Immunology · doi:10.1016/0198-8859(91)90088-q · Cited by 70
Riesgo coronario atribuible a los factores de riesgo cardiovascular en población española
Medrano, M. J., Pastor‐Barriuso, R., Boix, R., del Barrio, J. L., Damián, J., Álvarez, R., & Marín, A. (2007) · Revista Española de Cardiología · doi:10.1157/13113930 · Cited by 69
“Tabaquismo 32,7 44 1,71 (1,2-2,44) 2,6 (1,75-3,85) 18,9 (6,2-32) 27,1 (18,9-32,6) Hipercolesterolemia 24,8 40,2 1,53 (1,11-2,1) 1,97 (1,42-2,73) 11,6 (2,7-21,4) 19,8 (11,9-25,5) Hipertensión 34,1 46 1,45 (1,06-1,99) 1,24 (0,88-1,73) 13,3 (1,9-25,2) 8,9 (–6,3-19,4) Diabetes 9,9 29,4 1,96 (1,32-2,91) 1,52 (1-2,33) 8,7 (…”
The Impact of Health Behaviour on Long Term Sickness Absence: Results from DWECS/DREAM
Christensen, K. B., Lund, T., Labriola, M., Bültmann, U., & Villadsen, E. (2007) · Industrial Health · doi:10.2486/indhealth.45.348 · Cited by 69
Perinatal mortality and case fatality after placental abruption in Norway 1967-1991
Rasmussen, S., Irgens, L. M., Bergsjø, P., & Dalaker, K. (1996) · Acta Obstetricia Et Gynecologica Scandinavica · doi:10.3109/00016349609047092 · Cited by 66
Influence of Physicians' Management and Communication Ability on Patients' Persistence With Antihypertensive Medication
Tamblyn, R. M. (2010) · Archives of Internal Medicine · doi:10.1001/archinternmed.2010.167 · Cited by 69
Risk of cancer incidence and mortality associated with diabetes: A systematic review with trend analysis of 203 cohorts
Ling, S., Brown, K., Miksza, J. K., Howells, L. M., Morrison, A., Issa, E., Yates, T. E., Khunti, K., Davies, M. J., & Zaccardi, F. (2020) · Nutrition Metabolism and Cardiovascular Diseases · doi:10.1016/j.numecd.2020.09.023 · Cited by 70
Occupation and male lung cancer: a case-control study in northern Sweden.
Damber, L., & Larsson, L. (1987) · Occupational and Environmental Medicine · doi:10.1136/oem.44.7.446 · Cited by 67
Risk factors for fetal anaemia in a malarious area of Malawi
Brabin, B. J., Kalanda, B. F., Verhoeff, F. H., Chimsuku, L. H., & Broadhead, R. L. (2004) · Annals of Tropical Paediatrics · doi:10.1179/027249304225019136 · Cited by 67
Smoking and lung cancer with special regard to type of smoking and type of cancer. A case-control study in north Sweden
Damber, L., & Larsson, L. (1986) · British Journal of Cancer · doi:10.1038/bjc.1986.111 · Cited by 67
“The calculation of the population aetiologic fraction (AFPOP) for smoking was calculated according to the formula: AF -p=CFE x (RR-1)/RR, where CFE is case fraction (proportion of exposed cases) and RR relative risk (Miettinen, 1974).”
Method
Target groups for the prevention of late-life anxiety
Smit, F., Comijs, H., Schoevers, R., Cuijpers, P., Deeg, D., & Beekman, A. (2007) · British Journal of Psychiatry · doi:10.1192/bjp.bp.106.023127 · Cited by 65
“This indicates by how many percentage points the incidence of anxiety will be reduced when the adverse effect of the risk indicators is completely blocked (Miettinen, 1974; Rothman & Greenland, 1998).”
BackgroundMethod
Methods of Inference for Estimates of Absolute Risk Derived from Population-Based Case-Control Studies
Bénichou, J., & Gail, M. H. (1995) · Biometrics · doi:10.2307/2533324 · Cited by 66
Associations between cigarette smoking and the risk of four leading cancers in Miyagi Prefecture, Japan: A multi‐site case‐control study
Minami, Y., & Tateno, H. (2003) · Cancer Science · doi:10.1111/j.1349-7006.2003.tb01480.x · Cited by 66
The vision-related burden of dry eye
Morthen, M. K., Magnø, M. S., Utheim, T. P., et al. (2021) · The Ocular Surface · doi:10.1016/j.jtos.2021.10.007 · Cited by 65
Foods and beverages in relation to urothelial cancer: Case‐control study in Japan
Wakai, K., Hirose, K., Takezaki, T., et al. (2003) · International Journal of Urology · doi:10.1111/j.1442-2042.2004.00740.x · Cited by 65

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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