將疾病歸因於多重途徑：以因果圓派建模之方法

Abstract

探究暴露和疾病的關係是流行病學的宗旨。研究者有時會對由「果」（疾病）溯「因」（暴露）有興趣，即所謂的「歸因」。然而，目前的歸因方法未能考慮罹病的途徑。本研究中，我們以因果圓派模式為基礎，提出一個方法將疾病歸因於多重罹病途徑。我們針對三種不同的目的進行疾病的歸因，分別是罹病途徑的歸因、介入計畫的評估和侵權行為責任的分配。我們以一範例資料呈現本研究方法，並附上簡單易用的程式。我們推薦本研究方法成為流行病學研究分析的常規方法。

Characterizing exposure-disease associations is the central tenet of epidemiology. Researchers may want to evaluate exposure-disease associations by assessing whether “outcomes” (diseases) are induced by “causes” (exposures), which is the so-called “attribution”. However, current methods for disease attribution did not take disease pathways into consideration. In this paper, we propose a method to attribute diseases to multiple pathways based on the causal-pie model. The proposed method can be used to attribute diseases to pathways, to evaluate the intervention strategies and to apportion responsibility in tort-law liability issues. Our method is illustrated by an example data and an easy-to-use code is provided. We recommend the present method for routine use during the analysis of the epidemiologic data.