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Moscow, Russian Federation
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Russian Federation
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Russian Federation
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Russian Federation
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Russian Federation
GRNTI 76.03 Медико-биологические дисциплины
GRNTI 76.33 Гигиена и эпидемиология
OKSO 14.04.02 Ядерные физика и технологии
OKSO 31.06.2001 Клиническая медицина
OKSO 31.08.08 Радиология
OKSO 32.08.12 Эпидемиология
BBK 51 Социальная гигиена и организация здравоохранения. Гигиена. Эпидемиология
BBK 534 Общая диагностика
TBK 5708 Гигиена и санитария. Эпидемиология. Медицинская экология
TBK 5712 Медицинская биология. Гистология
TBK 5734 Медицинская радиология и рентгенология
TBK 6212 Радиоактивные элементы и изотопы. Радиохимия
Purpose: To summarize data on graduation of the effect size on the base of Hill’s first causality criterion ‘Strength of association’ on relative risk parameters (RR). Material and methods: Survey of published sources: monographs, handbooks, papers, educational material on statistics in various disciplines (including on-line), etc. (128 references; of which about 30 handbooks on epidemiology, carcinogenesis and medical statistics). Results: For the RR value, the collected data summary (1980–2018) implies non-homogeneity in concepts. The most common references are to the Monson scale (two editions of the monograph on the epidemiology of occupational exposures Monson R.R., 1980; 1990). In our opinion, the optimal graduation can be developed on the basis of this scale, and it should include both the range of no effect (RR = 0.9–1.2) and the weak (RR = 1.2–1.5, or 0.7–0.9), moderate (RR = 1.5–3.0, or 0.4–0.7), strong (RR = 3.0–10.0; or 0.1–0.4) and very strong’(RR = 10.0–40.0; or 0.0–0.1) ranges. Examples of epidemiological effects with overwhelming strength of association are presented (RR > 40.0). For the effects of thalidomide, RR reached thousands, for diethylstilbestrol, conditional infinity, and when irradiated in childhood, the frequency of some cancers increased tens and even hundreds of times. The juristic aspects of compensation payment based on RR are briefly reviewed. According to the Daubert rule (Daubert ruling, Daubert standard) on the 1993 precedent in the United States, risks are recognized only at RR > 2.0, when the probability of causality is more than 50 %. Conclusions: To estimate the RR value, one should use the most common and officially established Monson scale, albeit with an expansion in the range of dramatic or overhelming risks. This study can be used as a reference guide on the graduations of effect size on RR (OR) for a wide variety of observed disciplines.
graduation of effect size, ordinal scales, relative risk, epidemiology
1. Введение и постановка проблемы для цикла сообщений: ассоциации и критерии их причинности
Оценка причинности явлений и ассоциативных связей – краеугольный камень как нашей обыденной жизни [1], так и практически всех научных дисциплин, включая эмпирические и описательные: философии [2, 3], биологии, эпидемиологии, медицины, физики [4], химии [5], экономики [7], социологии [4, 8], юриспруденции [9], психологии [4] и др. [4, 10].
Во всех этих областях (кроме философии) доказательность может основываться на выявлении статистически значимых ассоциаций: между причиной и следствием, между воздействием и эффектом, между характеристикой группы и ее последующими поведенческими особенностями, и пр. [4]. В экспериментальных дисциплинах с возможностью устанавливать условия опыта, получение подобных доказательств очевидно (экспериментальным называется подход, когда можно проконтролировать хотя бы один варьирующий фактор из многих [11]). Выявление в эксперименте статистически значимой ассоциации или корреляции – это конечный этап доказательности (что относится и к рандомизированным контролируемым испытаниям в медицине [4, 11]) [12]. Данное положение, вероятно, настолько глубоко входит в подсознание экспериментаторов, что нередко распространяется ими (а, затем, и массами населения) на все остальные дисциплины и области человеческого деятельности, где никаких контрольных опытов поставить нельзя. То, что для описательных дисциплин, включающих вместе с эпидемиологией экономику, социологию, психологию и др., «ассоциация не означает каузацию» (то есть причинность; парафраз из [13]), какой бы статистической значимости ни была корреляция, ясно далеко не всем.
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