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Is the Association Causal, or Are There Alternative Explanations? 

Is the Association Causal, or Are There Alternative Explanations?
Is the Association Causal, or Are There Alternative Explanations?

Katherine M. Keyes

and Sandro Galea

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date: 05 August 2020

Associations observed between an exposure and a health indicator can arise because the exposure causes the health indicator of interest or because there is an alternative explanation for the association. Understanding this lies at the heart of step 5: rigorously evaluate the associations for internal validity. A fundamental driver of noncausal associations is non-comparability. Non-comparability arises when individuals who are exposed are not comparable to individuals who are unexposed on factors that are related to the health indicator. This chapter introduces the reader to fundamental concepts in non-comparability between the exposed and unexposed individuals and groups of individuals. Building on the counterfactual framework for conceptualizing a cause introduced in chapter 7, the chapter guides the reader through understanding the causal architecture that underlies non-comparability in epidemiologic studies, providing theoretical frameworks and examples.

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