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Effect Modification and Its Impact on Preventable and Attributable Fractions in the Potential Outcomes Framework
Bronner P Gonçalves1, Etsuji Suzuki2
1Faculty of Health and Medical Sciences, University of Surrey.
Journal of Epidemiology
|October 5, 2025
Summary
When exposure effects vary, preventable and attributable fractions require careful interpretation. Stratum-specific measures, weighted by subpopulation frequencies, offer a clearer understanding of public health impacts.
Area of Science:
- Epidemiology
- Biostatistics
- Public Health
Background:
- Policy decisions require measures reflecting exposure impact and current distribution.
- Preventable and attributable fractions are used, but interpretation is complex with subpopulation variation.
Purpose of the Study:
- To analyze preventable and attributable fractions considering effect modification.
- To formally define these measures using potential outcomes and clarify stratum weighting.
Main Methods:
- Utilized potential outcomes framework for formal definitions.
- Analyzed weighting of different strata in total population measures.
Main Results:
- Derivations show stratum-specific fractions are weighted by effect modifier frequencies among those with the outcome.
- Weights are valid for preventable and attributable proportions.
- Demonstrated impact of effect modification on measure interpretation through an example.
Conclusions:
- When effect modification is present, reporting stratum-specific measures is recommended.
- Provide information for quantifying implicit weights in total population estimates.
- Formal justification for this approach is provided.
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