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Pathway-specific population attributable fractions.

Maurice M O'Connell1, John P Ferguson1

  • 1Biostatistics Unit, HRB Clinical Research Facility Galway, School of Medicine, NUI Galway, Galway, Ireland.

International Journal of Epidemiology
|May 10, 2022
PubMed
Summary
This summary is machine-generated.

We introduce a new metric, the pathway-specific population attributable fraction (PS-PAF), to quantify disease burden through specific mediating pathways. This helps understand how risk factors like physical inactivity impact disease prevalence via different biological mechanisms.

Keywords:
Attributable fractioncausal inferencepotential outcomesrisk factor

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Area of Science:

  • Epidemiology
  • Biostatistics
  • Public Health

Background:

  • Population attributable fraction (PAF) estimates the proportion of disease preventable by eliminating an exposure.
  • Understanding the specific pathways through which risk factors impact disease is crucial for targeted interventions.
  • Sedentary lifestyles, for example, affect stroke risk through mediators like blood pressure and body mass index.

Purpose of the Study:

  • To define and develop a novel metric, the pathway-specific population attributable fraction (PS-PAF).
  • To provide a formal definition and derive estimands for PS-PAFs using a potential outcomes framework.
  • To develop computationally efficient estimators for PS-PAFs.

Main Methods:

  • Introduced the pathway-specific population attributable fraction (PS-PAF) metric.
  • Utilized a potential outcomes framework for formal definitions and identifiability conditions.
  • Derived computationally efficient estimators for PS-PAF.

Main Results:

  • Demonstrated calculations using the INTERSTROKE international case-control study.
  • Found that physical activity's mediating pathways (blood pressure, lipids, body size) explain comparable stroke burden.
  • Indicated that a significant portion of stroke burden from physical inactivity may operate through alternative pathways.

Conclusions:

  • PS-PAFs effectively measure disease burden attributable to specific mediating pathways.
  • This metric provides insights into the dominant mechanisms of risk factor-disease relationships at a population level.
  • PS-PAFs can inform public health strategies by highlighting key intervention points.