现实队列研究中暴露与结局的时序关系  

Exposure-preceding-outcome regarding time sequence among cohort studies in real world

作　　者：刘丽丽 何一宁 蔡倩莹 赵耐青 郑英杰 Liu Lili;He Yining;Cai Qianying;Zhao Naiqing;Zheng Yingjie(Department of Public Health Microbiology;Department of Epidemiology;Department of Biostatistics;Key Laboratory of Public Health Safety, Ministry of Education, 5.Key Laboratory for Health Technology Assessment, National Commission of Health and Family Planning, School of Public Health, Fudan University, Shanghai 200032 China)

机构地区：[1]复旦大学公共卫生学院卫生微生物学教研室,上海200032 [2]复旦大学公共卫生学院流行病学教研室,上海200032 [3]复旦大学公共卫生学院生物统计学教研室,上海200032 [4]复旦大学公共卫生学院公共卫生安全教育部重点实验室,上海200032 [5]复旦大学公共卫生学院国家卫生和计划生育委员会卫生技术评估重点实验室,上海200032

出　　处：《中华流行病学杂志》2018年第6期858-861,共4页Chinese Journal of Epidemiology

基　　金：国家自然科学基金（81373065,81773490）;国家重点研发计划“生物安全关键技术研发”重点专项（2017YFC1200203）;上海市第四轮公共卫生体系建设三年行动计划重点学科项目（15GWZK0202）

摘　　要：暴露在发生时间上先于结局，是队列研究的优点之一，因此在因果推断上优于其他观察性设计。本文应用有向无环图（Directed Acyclic Graphs，DAGs）构建了现实队列研究中易感人群的因果结构后发现：现实的队列研究以研究人群替换易感人群进行因果效应的估计，人群的暴露与结局在时序关系上可互为先后，因果效应估计的准确性受到替换人群的易感性和基线调查时结局识别和排除有效性的影响。One of the commonly accepted merits of cohort studies （CSs） refers to the exposure precedes outcome superior to other observational designs. We use Directed Acyclic Graphs to construct a causal graph among research populations under CSs. We notice that the substitution of research population in place of a susceptible one can be used for effect estimation. Its correctness depends on the outcome-free status of the substituted population and the performance of both screening and diagnosis regarding the outcomes under study at baseline. The temporal precedence of exposure over outcome occurs theoretically, despite the opposite happens in realities. Correct effect estimate is affected by both the suitability of population substitution and the validities of outcome identification and exclusion.

关 键 词：队列研究 时序关系 易感人群 有向无环图 因果关系 

分 类 号：R181[医药卫生—流行病学]