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Related Experiment Videos

Reverse epidemiology: a confusing, confounding, and inaccurate term.

Nathan W Levin1, Garry J Handelman, Josef Coresh

  • 1Renal Research Institute, New York, New York, USA. nlevin@rriny.com

Seminars in Dialysis
|November 10, 2007
PubMed
Summary
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The concept of "reverse epidemiology" in dialysis patients is misleading. Classical epidemiology rules apply, but confounding factors in end-stage renal disease require careful analysis of associations and causation.

Area of Science:

  • Nephrology
  • Epidemiology
  • Clinical Research

Background:

  • The term "reverse epidemiology" suggests altered risk factor-outcome relationships in dialysis patients.
  • Observed associations, such as obesity with decreased risk, contradict findings in healthy populations.
  • This has led to proposals of "reversed" epidemiological rules for these patients.

Purpose of the Study:

  • To critically evaluate the concept of "reverse epidemiology" in the context of end-stage renal disease (ESRD).
  • To emphasize the continued applicability of classical epidemiological principles in complex patient populations.
  • To highlight the importance of distinguishing association from causation and accounting for confounding and bias.

Main Methods:

  • Conceptual analysis of epidemiological principles.

Related Experiment Videos

  • Examination of confounding and bias in ESRD populations.
  • Review of risk factor-outcome associations in dialysis patients.

    • Main Results:

    • The authors argue that epidemiological rules are not reversed in dialysis patients.
    • Existing subclinical and clinical diseases significantly confound risk factor associations.
    • Lower cholesterol, for instance, is often a marker of poor health, not a healthy diet, in ESRD.

    Conclusions:

    • The term "reverse epidemiology" is potentially misleading and detrimental to understanding ESRD.
    • Classical epidemiological methods, applied rigorously, are essential for uncovering causal associations in ESRD.
    • Differences in risk factors are important but should be studied using established epidemiological frameworks.