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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BackgroundMethod
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Self-citation
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Improved and extended exact and asymptotic methods for the combination of 2 × 2 tables
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“The PARP represents the proportion of emotional disorders in the population of informal caregivers that can be reduced when the adverse effect of the risk indicator is completely eliminated [41].”
Background
Obesity, diabetes, serum glucose, and risk of primary liver cancer by birth cohort, race/ethnicity, and sex: Multiphasic health checkup study
Petrick, J. L., Freedman, N. D., Demuth, J., Yang, B., Eeden, S. K. V. D., Engel, L. S., & McGlynn, K. A. (2016) · Cancer Epidemiology · doi:10.1016/j.canep.2016.04.009 · Cited by 30
“Adjusted population attributable fractions (PAFs) for BMI and diabetes were computed utilizing a method for estimating PAFs from population-based case-controls studies with an adjusted odds ratios [28,29].”
Respiratory Viral Detections During Symptomatic and Asymptomatic Periods in Young Andean Children
Howard, L. M., Johnson, M., Williams, J. V., Zhu, Y., Gil, A. I., Edwards, K. M., Griffin, M. R., Lanata, C. F., & Grijalva, C. G. (2015) · The Pediatric Infectious Disease Journal · doi:10.1097/inf.0000000000000812 · Cited by 31
Contribution of sickle cell disease to the occurrence of developmental disabilities: A population-based study
Ashley‐Koch, A. E., Murphy, C. C., Khoury, M. J., & Boyle, C. A. (2001) · Genetics in Medicine · doi:10.1097/00125817-200105000-00006 · Cited by 30
Endometrial cancer: Population attributable risks from reproductive, familial and socioeconomic factors
Hemminki, K., Bermejo, J. L., & Granström, C. (2005) · European Journal of Cancer · doi:10.1016/j.ejca.2005.03.031 · Cited by 30
“For each variable, the population was classified dichotomously (exposed/unexposed) and PAF was calculated according to the formula (RR 1)/RR · the proportion of cases in the exposed population, where RR is the relative risk in the exposed population [37].”
BackgroundMethod
Population Attributable Fraction of Incident Dementia Associated With Hearing Loss
Ishak, E. M., Burg, E. A., Pike, J. R., Martínez-Amezcua, P., Jiang, K., Powell, D. S., Huang, A., Suen, J. J., Lutsey, P. L., Sharrett, A. R., et al. (2025) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2025.0192 · Cited by 29
Trends in State Policy Support for Sexual Minorities and HIV-Related Outcomes Among Men Who Have Sex With Men in the United States, 2008–2014
Hatzenbuehler, M. L., McKetta, S. C., Goldberg, N. G., Sheldon, A., Friedman, S. R., Cooper, H. L. F., Beane, S., Williams, L. D., Tempalski, B. J., Smith, J. C., et al. (2020) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000002395 · Cited by 29
Potentially modifiable classic risk factors and their impact on incident myocardial infarction: results from the EPIC-Potsdam study
Heidemann, C., Hoffmann, K., Klipstein‐Grobusch, K., Weikert, C., Pischon, T., Hense, H., & Boeing, H. (2007) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000238392.19847.4c · Cited by 29
Familial risks of aortic aneurysms among siblings in a nationwide Swedish study
Hemminki, K., Li, X., Johansson, S.-E., et al. (2006) · Genetics in Medicine · doi:10.1097/01.gim.0000195973.60136.48 · Cited by 29
Protective effect of Bacillus Calmette Guerin (BCG) against leprosy: a population-based case-control study in Nagpur, India
ZODPEY, S. P., Bs, B., Shrikhande, S., et al. (1999) · Leprosy Review · doi:10.5935/0305-7518.19990032 · Cited by 29
An improved aetiologic fraction for alcohol‐caused mortality
Holman, C. D. J., & English, D. R. (1995) · Australian Journal of Public Health · doi:10.1111/j.1753-6405.1995.tb00363.x · Cited by 28
Season of Birth and Childhood Psychosis
Fombonne, E. J. (1989) · The British Journal of Psychiatry · doi:10.1192/s0007125000018158 · Cited by 31
State of the Science of Structural Stigma and LGBTQ+ Health: Meta-Analytic Evidence, Research Gaps, and Future Directions
Lattanner, M. R., McKetta, S. C., Pachankis, J. E., & Hatzenbuehler, M. L. (2024) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-071723-013336 · Cited by 41
Risk of Lung Cancer Associated With Occupational Exposure to Mineral Wools
Guida, F., Paget‐Bailly, S., Lamkarkach, F., et al. (2013) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0b013e318289ee8b · Cited by 27
Estimates of the current and future burden of melanoma attributable to ultraviolet radiation in Canada
O'Sullivan, D. E., Brenner, D. R., Villeneuve, P. J., et al. (2019) · Preventive Medicine · doi:10.1016/j.ypmed.2019.03.012 · Cited by 27
Occupational cancer in Britain
Hutchings, S. J., & Rushton, L. (2012) · British Journal of Cancer · doi:10.1038/bjc.2012.113 · Cited by 27
“If the RR was extracted from a population-based study, the estimate of the proportion of cases exposed was extracted directly from the study, and Miettinen’s equation (Miettinen, 1974) was used for calculating the AF:”
Method
Identifying target groups for the prevention of anxiety disorders in the general population
Batelaan, N. M., Smit, F., De Graaf, R., Van Balkom, A. J. L. M., Vollebergh, W. A. M., & Beekman, A. T. F. (2010) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2009.01488.x · Cited by 27
“This selection process is based on four indices that are of relevance to public mental health: the exposure rate (ER), the OR, the population attributable fraction [PAF (33)] and the number needed to be treated [NNT (34)].”
Background
Measuring Alcohol-Related Consequences in School Surveys: Alcohol-Attributable Consequences or Consequences With Students’ Alcohol Attribution
Gmel, G. E., Kuntsche, E. N., Wicki, M., & Labhart, F. (2009) · American Journal of Epidemiology · doi:10.1093/aje/kwp331 · Cited by 28
“AAFs were calculated according to the following standard formula (2, 3):”
Burden of Peripheral Artery Disease on Mortality and Incident Cardiovascular Events
Unkart, J., Allison, M., Araneta, M. R. G., Ix, J. H., Matsushita, K., & Criqui, M. H. (2020) · American Journal of Epidemiology · doi:10.1093/aje/kwaa051 · Cited by 28
Effect of Smoking on Breast Cancer by Adjusting for Smoking Misclassification Bias and Confounders Using a Probabilistic Bias Analysis Method
Pakzad, R., Nedjat, S., Yaseri, M., Salehiniya, H., Mansournia, N., Nazemipour, M., & Mansournia, M. A. (2020) · Clinical Epidemiology · doi:10.2147/clep.s252025 · Cited by 27

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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