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What Is a Cause? 

What Is a Cause?
Chapter:
What Is a Cause?
Author(s):

Katherine M. Keyes

and Sandro Galea

DOI:
10.1093/med/9780199331246.003.0007
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date: 01 June 2020

Identifying factors that cause disease is the central driving force behind the discipline of epidemiology. Preceding chapters discuss how to measure associations in epidemiology; this chapter considers causal associations. The chapter articulates a framework focusing on the counterfactual approach to defining a cause and guides the reader through disease causation at the individual and population level. It presents disease causation in the population using the example of marbles and a marble jar through which certain combinations of marbles cause disease. Using the metaphor of the marble jar, the chapter discusses disease causation across the life course, offering a formulation for expressing disease causation in the context of connected networks of individuals who share exposures and may transmit diseases to one another. The chapter explains a framework for conceptualizing multiple causes of disease as exposures that interact and describes why the assessment of causes are often probabilistic rather than deterministic.

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