1
|
Guthmuller S, Carrieri V, Wübker A. Effects of organized screening programs on breast cancer screening, incidence, and mortality in Europe. JOURNAL OF HEALTH ECONOMICS 2023; 92:102803. [PMID: 37688931 DOI: 10.1016/j.jhealeco.2023.102803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/11/2023]
Abstract
We link data on regional Organized Screening Programs (OSPs) throughout Europe with survey data and population-based cancer registries to estimate effects of OSPs on breast cancer screening (mammography), incidence, and mortality. Identification is from regional variation in the existence and timing of OSPs, and in their age-eligibility criteria. We estimate that OSPs, on average, increase mammography by 25 percentage points, increase breast cancer incidence by 16% five years after the OSPs implementation, and reduce breast cancer mortality by about 10% ten years after.
Collapse
Affiliation(s)
- Sophie Guthmuller
- Health Economics and Policy group, Department of Socioeconomics, Vienna University of Economics and Business, Welthandelsplatz 1, Building D4 1020 Vienna, Austria; RWI-Leibniz Institute for Economic Research, Hohenzollernstr. 1-3 45128 Essen, Germany; European Commission, Joint Research Centre, Ispra, VA, Italy.
| | - Vincenzo Carrieri
- RWI-Leibniz Institute for Economic Research, Hohenzollernstr. 1-3 45128 Essen, Germany; Department of Political and Social Sciences, University of Calabria 87036, Rende, Italy; Forschungsinstitut zur Zukunft der Arbeit (IZA), Schaumburg-Lippe-Straße 5-9 53113 Bonn, Germany
| | - Ansgar Wübker
- RWI-Leibniz Institute for Economic Research, Hohenzollernstr. 1-3 45128 Essen, Germany; Hochschule Harz, Friedrichstraße 57-59 38855 Wernigerode, Germany
| |
Collapse
|
2
|
Mirzaei-Alavijeh M, Jerome-D”Emilia B, Najafi F, Moradinazar M, Pirouzeh R, Jalilian F. Inequality in mammography uptake: results from recruitment phase of first cohort study among Iranian Kurdish population. Glob Health Res Policy 2022; 7:43. [DOI: 10.1186/s41256-022-00277-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Background
Breast cancer is the most common malignant disease in women and is the leading cause of cancer deaths among women. Mammography is the best and the most available diagnostic method for breast cancer early detection. The aim of this study was to investigate the prevalence and inequality in the mammography uptake among Kurdish women in the west of Iran.
Methods
This cohort study was conducted using data extracted from the Ravansar Non-communicable Cohort Study among Kurdish women in the west of Iran from 2014 to 2018. The sample included 5289 women aged 35–65 years. The relative and generalized (absolute) concentration index (RC and GC, respectively) was used to quantify and decompose socioeconomic inequalities in mammography uptake.
Results
Overall concentration index for mammography was 0.2107, indicating that the mammography uptake concentration was greater in women with a higher socioeconomic status (SES). The predictor variables accounted for 44.6% of the inequality in the mammography uptake. Higher SES, living in urban areas, and age group of 51–55 years old increased the chance of having a mammogram. Available evidence supports the inequality of mammography uptake in favor of women with higher SES.
Conclusions
Cost-free screening services for low SES women, and the development of breast cancer prevention campaigns focusing on disadvantaged women could have an important role in mammography uptake and in the reduction of inequalities.
Collapse
|
3
|
Bulliard JL, Bovio N, Arveux P, Bergeron Y, Chiolero A, Fournier E, Germann S, Konzelmann I, Maspoli M, Rapiti E, Canu IG. Occupational Factors and Socioeconomic Differences in Breast Cancer Risk and Stage at Diagnosis in Swiss Working Women. Cancers (Basel) 2022; 14:cancers14153713. [PMID: 35954377 PMCID: PMC9367372 DOI: 10.3390/cancers14153713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/12/2022] [Accepted: 07/28/2022] [Indexed: 12/07/2022] Open
Abstract
Socioeconomic differences in breast cancer (BC) incidence are driven by differences in lifestyle, healthcare use and occupational exposure. Women of high socioeconomic status (SES) have a higher risk of BC, which is diagnosed at an earlier stage, than in low SES women. As the respective effects of occupation and SES remain unclear, we examined the relationships between occupation-related variables and BC incidence and stage when considering SES. Female residents of western Switzerland aged 18−65 years in the 1990 or 2000 census, with known occupation, were linked with records of five cancer registries to identify all primary invasive BC diagnosed between 1990 and 2014 in this region. Standardized incidence ratios (SIRs) were computed by occupation using general female population incidence rates, with correction for multiple comparisons. Associations between occupation factors and BC incidence and stage at diagnosis were analysed by negative binomial and multinomial logistic regression models, respectively. The cohort included 381,873 women-years and 8818 malignant BC, with a mean follow-up of 14.7 years. Compared with reference, three occupational groups predominantly associated with a high socioprofessional status had SIRs > 1: legal professionals (SIR = 1.68, 95%CI: 1.27−2.23), social science workers (SIR = 1.29; 95%CI: 1.12−1.49) and some office workers (SIR = 1.14; 95%CI: 1.09−1.20). Conversely, building caretakers and cleaners had a reduced incidence of BC (SIR = 0.69, 95%CI: 0.59−0.81). Gradients in BC risk with skill and socioprofessional levels persisted when accounting for SES. A higher incidence was generally associated with a higher probability of an early-stage BC. Occupation and SES may both contribute to differences in risk and stage at diagnosis of BC.
Collapse
Affiliation(s)
- Jean-Luc Bulliard
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
- Neuchâtel and Jura Cancer Registry, 2000 Neuchâtel, Switzerland;
- Correspondence:
| | - Nicolas Bovio
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
| | - Patrick Arveux
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
| | - Yvan Bergeron
- Fribourg Cancer Registry, 1701 Fribourg, Switzerland;
| | - Arnaud Chiolero
- Population Health Laboratory (#PopHealthLab), University of Fribourg, 1700 Fribourg, Switzerland;
- Valais Cancer Registry, Valais Health Observatory, 1950 Sion, Switzerland;
| | - Evelyne Fournier
- Geneva Cancer Registry, University of Geneva, 1211 Geneva, Switzerland; (E.F.); (E.R.)
| | - Simon Germann
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
| | | | - Manuela Maspoli
- Neuchâtel and Jura Cancer Registry, 2000 Neuchâtel, Switzerland;
| | - Elisabetta Rapiti
- Geneva Cancer Registry, University of Geneva, 1211 Geneva, Switzerland; (E.F.); (E.R.)
| | - Irina Guseva Canu
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, 1010 Lausanne, Switzerland; (N.B.); (P.A.); (S.G.); (I.G.C.)
| |
Collapse
|
4
|
Audiger C, Bovagnet T, Bardes J, Abihsera G, Nicolet J, Deghaye M, Bochaton A, Menvielle G. Social Inequalities in Participation in Cervical Cancer Screening in a Metropolitan Area Implementing a Pilot Organised Screening Programme (Paris Region, France). Int J Public Health 2022; 67:1604562. [PMID: 35859669 PMCID: PMC9289096 DOI: 10.3389/ijph.2022.1604562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/30/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives: We aimed to examine social inequalities in participation in cervical cancer screening (CCS) in a metropolitan area by implementing a pilot organised screening programme. The pilot programme consisted of sending invitations to women who did not perform a pap smear within the past 3 years, managing interventions to reach vulnerable women, training healthcare professionals, and organising follow-ups of abnormal pap smears. Methods: We studied participation in CCS between January 2014 and December 2016 among 241,257 women aged 25-63 years old. To assess relative inequalities, Odds Ratios were computed using multilevel logistic regression. To assess absolute inequalities, the CCS coverage and the rate difference were calculated. Inequalities were computed by age and neighbourhood characteristics (social deprivation and proportion of single women). Results: Disparities in participation in CCS were observed by age and social deprivation. For overall screening compared to opportunistic screening, disparities by age were larger (OR25-35_vs._55-64 = 2.13 [2.08-2.19] compared to 2.02 [1.96-2.07]), but disparities by social deprivation were decreased (OR10%_most_vs._10%_least_deprived = 2.09 [1.90-2.30] compared to 2.22 [2.02-2.44]). Conclusion: Disparities in CCS participation remain despite the organised programme. To reduce these inequalities, free screening should be proposed and evaluated.
Collapse
Affiliation(s)
- Céline Audiger
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Thomas Bovagnet
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - Julia Bardes
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Gaëlle Abihsera
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Jérôme Nicolet
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Michel Deghaye
- Le Centre Régional de Coordination des Dépistages des Cancers-CRCDC, Paris, France
| | - Audrey Bochaton
- Université Paris Nanterre, UMR CNRS 7533 LADYSS, Nanterre, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d’épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| |
Collapse
|
5
|
Jolidon V. Gender inequality and mammography screening: Does living with a partner improve women's mammography uptake? Soc Sci Med 2022; 298:114875. [PMID: 35276623 DOI: 10.1016/j.socscimed.2022.114875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/29/2022] [Accepted: 02/27/2022] [Indexed: 11/19/2022]
Abstract
Macrolevel gender inequality is defined as the unequal distribution of power and resources between men and women shaped by macrolevel social structures and institutions. An emerging line of health research is emphasising its negative consequences on women's health and healthcare access. The present study examines how gender inequality contexts affect women's mammography screening uptake. It adopts a macrosociological and institutionalist approach on preventive healthcare use and compares women who live with a partner with those who do not. This is the first study to test the effect of macrolevel gender inequality on mammography uptake across the 26 Swiss cantons (i.e. regions). The Swiss cantons' autonomy to manage their political and healthcare systems, as provided by the federal system, offers an ideal setting for the comparative analysis of macrolevel factors. Data on 9724 women aged 50-70 from the Swiss Health Interview Survey (waves 2007, 2012 and 2017) is analysed. Multilevel logistic models estimate two canton-level indicators of gender inequality, the gender gaps in time use and full-time employment, and their association with mammography uptake, controlling for women's socioeconomic and demographic characteristics, health status and healthcare use. Cross-level interactions assess how these indicators moderate the mammography uptake of women living with and without a partner. Results show that in cantons with higher gender inequality, women have a lower probability of mammography uptake. Women who live with a partner have a higher mammography uptake than those who do not. However, this advantage is moderated by canton-level gender inequality, namely, women who live with a partner in more gender unequal cantons have a lower mammography uptake than their counterparts who reside in more gender equal cantons. Results support the hypothesis that macrolevel gender inequality moderates women's preventive healthcare uptake, from an institutionalist approach.
Collapse
Affiliation(s)
- Vladimir Jolidon
- Institute of Sociological Research, University of Geneva, 40 Bd du Pont-d'Arve, 1205, Genève, Switzerland.
| |
Collapse
|
6
|
Jolidon V, De Prez V, Bracke P, Bell A, Burton-Jeangros C, Cullati S. Revisiting the Effects of Organized Mammography Programs on Inequalities in Breast Screening Uptake: A Multilevel Analysis of Nationwide Data From 1997 to 2017. Front Public Health 2022; 10:812776. [PMID: 35198524 PMCID: PMC8858931 DOI: 10.3389/fpubh.2022.812776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/13/2022] [Indexed: 01/04/2023] Open
Abstract
This study revisits the effects of mammography screening programs on inequalities in breast screening uptake in Switzerland. The progressive introduction of regional mammography programs by 12 out of the 26 Swiss cantons (regions) since 1999 offers an opportunity to perform an ecological quasi-experimental study. We examine absolute income and marital status inequalities in mammography uptake, and whether the cantons' implementation of mammography programs moderate these inequalities, as previous research has devoted little attention to this. We use five waves of the Swiss Health Interview Survey covering the 1997–2017 period and comprising data on 14,267 women aged 50–70. Both up-to-date and ever-screening outcomes are analyzed with multilevel models which assess the mammography programs' within-canton effect. Findings show that higher income women and married women (compared to unmarried women) had significantly higher mammography uptake probabilities. Mammography programs did not moderate absolute income differences in up-to-date screening; however, they were associated with smaller absolute income differences in ever-screening uptake. Mammography programs related to higher screening uptake for married women, more than for unmarried women. In conclusion, we showed absolute income inequalities in mammography uptake which were not revealed by previous studies using relative inequality measures. Mammography programs may have contributed to reducing income inequalities in ever-screening, yet this was not observed for up-to-date screening. This study has implication for preventive health interventions—e.g., cancer screening promotion should pay attention to women's marital status since screening programs may widen the screening gap between married and unmarried women.
Collapse
Affiliation(s)
- Vladimir Jolidon
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- *Correspondence: Vladimir Jolidon
| | | | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Andrew Bell
- Sheffield Methods Institute, University of Sheffield, Sheffield, United Kingdom
| | | | - Stéphane Cullati
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
| |
Collapse
|
7
|
De Prez V, Jolidon V, Willems B, Cullati S, Burton-Jeangros C, Bracke P. Cervical cancer screening programs and their context-dependent effect on inequalities in screening uptake: a dynamic interplay between public health policy and welfare state redistribution. Int J Equity Health 2021; 20:211. [PMID: 34560888 PMCID: PMC8464130 DOI: 10.1186/s12939-021-01548-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While organized and opportunistic cervical cancer screening (CCS) programs implemented across the European Union have increased participation rates, barriers to socioeconomically deprived women remain substantial, implying high levels of inequality in CCS uptake. AIM This study assesses how the screening strategy (as a score based on the availability of organized population-based CCS programs), accessibility of the healthcare system (as an index of out-of-pocket expenditure as a proportion of total healthcare costs, public health expenditure as a percentage of total GDP, and general practitioner (GP) density per 10'000 inhabitants) and social protection (as a decommodification index), impact education- and income-based inequalities in CCS uptake. METHODS A two-level design with 25-64-year-old women (N = 96'883), eligible for Pap smear screening, nested in 28 European countries, was used to analyze data from the European Health Interview Survey's second wave, using multilevel logistic regression modelling. RESULTS Clear educational and income gradients in CCS uptake were found, which were smaller in countries with organized CCS programs, higher accessibility of the healthcare system and a higher level of decommodification. Furthermore, three-way interaction terms revealed that these gradients were smaller when organized CCS programs were implemented in countries with better accessibility of the healthcare system or a high level of decommodification. CONCLUSION This study indicates that the combination of organized screening and high accessibility of the healthcare system or social protection is essential for having lower levels of inequality in CCS uptake. In such countries, the structural threshold for poorer and lower educated women to engage in CCS is lower. This may be explained by them having a better interaction with their GP, who may convince them of the screening test, lower out-of-pocket payments, and financial support to buffer against a disadvantageous position on the labor market.
Collapse
Affiliation(s)
- Vincent De Prez
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium.
| | - Vladimir Jolidon
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland
| | - Barbara Willems
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| | - Stéphane Cullati
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland.,Population Health Laboratory, Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Ch. du Musée 8, CH-1700, Fribourg, Switzerland
| | - Claudine Burton-Jeangros
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, 40 bd du Pont-d'Arve, CH- 1211, Geneve 4, Switzerland
| | - Piet Bracke
- Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
| |
Collapse
|
8
|
Ghanbari A, Rahmatpour P, Hosseini N, Khalili M. Social Determinants of Breast Cancer Screening among Married Women: A Cross-Sectional Study. J Res Health Sci 2020; 20:e00467. [PMID: 32814688 PMCID: PMC7585759 DOI: 10.34172/jrhs.2020.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Regular cancer screening is the best way for early detection of breast cancer, but studies showed the low participation rates of screening in Iran. We aimed to determine breast cancer screening among married women and related factors in North of Iran. STUDY DESIGN A cross-sectional study. METHODS This cross-sectional study was carried out from Jan to Mar 2017 among 1472 married women in an urban population in Rasht City, North of Iran. Data were collected using a questionnaire included socio-demographic information and breast cancer screening behaviors. Descriptive statistics, chi-square and logistic regression were used for data analyzing with SPSS. RESULTS The mean age of women was 35.1 ±6.5 years. Majority of women never performed clinical breast examination (70.7%) and regular monthly breast self-examination (52.2%). Only women over 40 yr performed mammography. Mammography performance was associated with health insurance (OR=4.99; 95% CI: 1.10, 22.53) and family history (OR=1.60; 95% CI: 1.19, 2.19), clinical breast examination was associated with age of women (OR=2.87; 95% CI: 1.90, 4.32) and breast self-examination was associated with age and occupation of women [OR=1.67; 95 % CI: 1.16, 2.39, OR=1.65; 95% CI: 1.19, 2.29) respectively]. CONCLUSION The rate of breast cancer screening was low among married women. Therefore considering the structural and cultural barriers, effective health education is essential to reduce inequality and increase the efficiency of screening programs.
Collapse
Affiliation(s)
- Atefeh Ghanbari
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Pardis Rahmatpour
- PhD Candidate in Nursing, Iran University of Medical Sciences, Tehran,
| | - Narges Hosseini
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Malahat Khalili
- Department of Epidemiology and Biostatistics, School of Public Health, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
9
|
Padilla CM, Painblanc F, Soler-Michel P, Vieira VM. Mapping Variation in Breast Cancer Screening: Where to Intervene? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2274. [PMID: 31252599 PMCID: PMC6651541 DOI: 10.3390/ijerph16132274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/07/2019] [Accepted: 06/22/2019] [Indexed: 11/24/2022]
Abstract
Small geographic areas with lower mammography screening participation rates may reflect gaps in screening efforts. Our objective was to use spatial analyses to understand disparities in mammography screening use and to identify factors to increase its uptake in areas that need it in Lyon metropolitan area, France. Data for screened women between the ages of 50 and 74 were analyzed. Census blocks of screened and non screened women were extracted from the mammography screening programme 2015-2016 dataset. We used spatial regression models, within a generalized additive framework to determine clusters of census blocks with significantly higher prevalence of non-participation of mammography screening. Smoothed risk maps were crude and adjusted on the following covariates: deprivation index and opportunistic screening. Among 178,002 women aged 50 to 74, 49.9% received mammography screening. As hypothesized, women living in highly deprived census blocks had lower participation rates compared to less deprived blocks, 45.2% vs. 51.4% p < 0.001. Spatial analyses identified four clusters, one located in an urban area and three in suburban areas. Moreover, depending on the location of the cluster, the influence came from different variables. Knowing the impact of site-specific risk factors seems to be important for implementing an appropriate prevention intervention.
Collapse
Affiliation(s)
- Cindy M Padilla
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France.
| | - François Painblanc
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France
| | - Patricia Soler-Michel
- Centre régional de coordination des dépistages des cancers Auvergne Rhône Alpes, 5 bis, rue Cléberg, 69322 Lyon CEDEX 05, France
| | - Veronica M Vieira
- Program in Public Health, University of California, Irvine, CA 92697, USA
| |
Collapse
|
10
|
Harper S. A Future for Observational Epidemiology: Clarity, Credibility, Transparency. Am J Epidemiol 2019; 188:840-845. [PMID: 30877294 DOI: 10.1093/aje/kwy280] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022] Open
Abstract
Observational studies are ambiguous, difficult, and necessary for epidemiology. Presently, there are concerns that the evidence produced by most observational studies in epidemiology is not credible and contributes to research waste. I argue that observational epidemiology could be improved by focusing greater attention on 1) defining questions that make clear whether the inferential goal is descriptive or causal; 2) greater utilization of quantitative bias analysis and alternative research designs that aim to decrease the strength of assumptions needed to estimate causal effects; and 3) promoting, experimenting with, and perhaps institutionalizing both reproducible research standards and replication studies to evaluate the fragility of study findings in epidemiology. Greater clarity, credibility, and transparency in observational epidemiology will help to provide reliable evidence that can serve as a basis for making decisions about clinical or population-health interventions.
Collapse
Affiliation(s)
- Sam Harper
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec
- Institute for Health and Social Policy, McGill University, Montreal, Quebec
| |
Collapse
|