Causal and Associational Language in Observational Health Research: A Systematic Evaluation

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Haber, Noah A
Wieten, Sarah E
Rohrer, Julia M
Arah, Onyebuchi A
Tennant, Peter WG
Stuart, Elizabeth A
Murray, Eleanor J
Pilleron, Sophie
Lam, Sze Tung
Riederer, Emily
Howcutt, Sarah Jane
Simmons, Alison E
Leyrat, Clémence
Schoenegger, Philipp
Takashima, Mari
et al.
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2022
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Abstract

We estimated the degree to which language used in the high profile medical/public health/epidemiology literature implied causality using language linking exposures to outcomes and action recommendations; examined disconnects between language and recommendations; identified the most common linking phrases; and estimated how strongly linking phrases imply causality. We searched and screened for 1,170 articles from 18 high-profile journals (65 per journal) published from 2010-2019. Based on written framing and systematic guidance, three reviewers rated the degree of causality implied in abstracts and full text for exposure/outcome linking language and action recommendations. Reviewers rated the causal implication of exposure/outcome linking language as None (no causal implication) in 13.8%, Weak 34.2%, Moderate 33.2%, and Strong 18.7% of abstracts. The implied causality of action recommendations was higher than the implied causality of linking sentences for 44.5% or commensurate for 40.3% of articles. The most common linking word in abstracts was "associate" (45.7%). Reviewers' ratings of linking word roots were highly heterogeneous; over half of reviewers rated "association" as having at least some causal implication. This research undercuts the assumption that avoiding "causal" words leads to clarity of interpretation in medical research.

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American Journal of Epidemiology

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© 2022 Oxford University Press. This is a pre-copy-editing, author-produced PDF of an article accepted for publication in American Journal of Epidemiology following peer review. The definitive publisher-authenticated version Causal and Associational Language in Observational Health Research: A Systematic Evaluation, American Journal of Epidemiology, 2022 is available online at: https://doi.org/10.1093/aje/kwac137.

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Mathematical sciences

association

causal inference

causal language

observational study

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Haber, NA; Wieten, SE; Rohrer, JM; Arah, OA; Tennant, PWG; Stuart, EA; Murray, EJ; Pilleron, S; Lam, ST; Riederer, E; Howcutt, SJ; Simmons, AE; Leyrat, C; Schoenegger, P; Booman, A et al., Causal and Associational Language in Observational Health Research: A Systematic Evaluation., American Journal of Epidemiology, 2022, pp. kwac137

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