This article needs attention from an expert in medicine. The specific problem is: defining, "determinant," a complicated, poorly harmonized concept in medicine. Some sources use the term loosely while others use it as a technical term..WikiProject Medicine may be able to help recruit an expert.(July 2019)
Due to a lack of harmonization across disciplines, determinant, in its more widely accepted scientific meaning, is often used as a synonym. The main difference lies in the realm of practice: medicine (clinical practice) versus public health. As an example from clinical practice, low ingestion of dietary sources of vitamin C is a known risk factor for developing scurvy. Specific to public health policy, a determinant is a health risk that is general, abstract, related to inequalities, and difficult for an individual to control.[2][3][4] For example, poverty is known to be a determinant of an individual's standard of health.
Risk factors or determinants are correlational and not necessarily causal, because correlation does not prove causation. For example, being young cannot be said to cause measles, but young people have a higher rate of measles because they are less likely to have developed immunity during a previous epidemic. Statistical methods are frequently used to assess the strength of an association and to provide causal evidence, for example in the study of the link between smoking and lung cancer. Statistical analysis along with the biological sciences can establish that risk factors are causal. Some prefer the term risk factor to mean causal determinants of increased rates of disease, and for unproven links to be called possible risks, associations, etc.[citation needed]
When done thoughtfully and based on research, identification of risk factors can be a strategy for medical screening.[5]
Relative risk, such as "A woman is more than 100 times more likely to develop breast cancer in her 60s than in her 20s."[6]
Fraction of incidences occurring in the group having the property of or being exposed to the risk factor, such as "99% of breast cancer cases are diagnosed in women."[7]
Increase in incidence in the exposed group, such as "each daily alcoholic beverage increases the incidence of breast cancer by 11 cases per 1000 women."[8]
Hazard ratio, such as "an increase in both total and invasive breast cancers in women randomized to receive estrogen and progestin for an average of 5 years, with a hazard ratio of 1.24 compared to controls."[9]
Example
At a wedding, 74 people ate the chicken and 22 of them were ill, while of the 35 people who had the fish or vegetarian meal only 2 were ill. Did the chicken make the people ill?
So the chicken eaters' risk = 22/74 = 0.297 And non-chicken eaters' risk = 2/35 = 0.057.
Those who ate the chicken had a risk over five times as high as those who did not, that is, a relative risk of more than five. This suggests that eating chicken was the cause of the illness, but this is not proof.
This example of a risk factor is described in terms of the relative risk it confers, which is evaluated by comparing the risk of those exposed to the potential risk factor to those not exposed.
General determinants
The probability of an outcome usually depends on an interplay between multiple associated variables. When performing epidemiological studies to evaluate one or more determinants for a specific outcome, the other determinants may act as confounding factors, and need to be controlled for, e.g. by stratification. The potentially confounding determinants varies with what outcome is studied, but the following general confounders are common to most epidemiological associations, and are the determinants most commonly controlled for in epidemiological studies:[citation needed]
Age (0 to 1.5 years for infants, 1.5 to 6 years for young children, etc.)
A risk marker is a variable that is quantitatively associated with a disease or other outcome, but direct alteration of the risk marker does not necessarily alter the risk of the outcome. For example, driving-while-intoxicated (DWI) history is a risk marker for pilots as epidemiologic studies indicate that pilots with a DWI history are significantly more likely than their counterparts without a DWI history to be involved in aviation crashes.[13]
^ abParritz, Robin Hornik (2017-05-24). Disorders of childhood : development and psychopathology. Troy, Michael F. (Michael Francis) (Third ed.). Boston, MA. ISBN9781337098113. OCLC 960031712.
^Improving Health in the Community: A Role for Performance Monitoring: 2. Understanding Health and Its Determinants: A Model of the Determinants of Health. National Academy of Sciences: National Academies Press: Institute of Medicine (US) Committee on Using Performance Monitoring to Improve Community Health. 1997. ISBN978-0309055345. Unlike a biomedical model that views health as the absence of disease, this dynamic framework includes functional capacity and well-being as health outcomes of interest. It also presents the behavioral and biologic responses of individuals as factors that influence health but are themselves influenced by social, physical, and genetic factors that are beyond the control of the individual.
^"Health Impact Assessment (HIA): Glossary of terms used". World Health Organization. Retrieved July 20, 2019.
^. World Health Organization. Archived from the original on May 30, 2004. Retrieved July 20, 2019.
^Wald, N. J.; Hackshaw, A. K.; Frost, C. D. (1999). "When can a risk factor be used as a worthwhile screening test?". BMJ. 319 (7224): 1562–1565. doi:10.1136/bmj.319.7224.1562. ISSN 0959-8138. PMC1117271. PMID 10591726.
^Margolese RG, Fisher B, Hortobagyi GN, Bloomer WD (2000). "Neoplasms of the Breast". In Bast RC, Kufe DW, Pollock RE, et al. (eds.). Cancer Medicine (5th ed.). Hamilton, Ontario: B. C. Decker. §Risk Factors. ISBN1-55009-113-1. Retrieved 27 January 2011.
^Giordano SH, Cohen DS, Buzdar AU, Perkins G, Hortobagyi GN (July 2004). "Breast carcinoma in men: a population-based study". Cancer. 101 (1): 51–7. doi:10.1002/cncr.20312. PMID 15221988. S2CID 972345.
^Allen NE, Beral V, Casabonne D, et al. (March 2009). "Moderate alcohol intake and cancer incidence in women". Journal of the National Cancer Institute. 101 (5): 296–305. doi:10.1093/jnci/djn514. PMID 19244173.
^Heiss, G.; Wallace, R.; Anderson, G. L.; Aragaki, A.; Beresford, S. A. A.; Brzyski, R.; Chlebowski, R. T.; Gass, M.; Lacroix, A. (2008). "Health Risks and Benefits 3 Years After Stopping Randomized Treatment with Estrogen and Progestin" (PDF). JAMA: The Journal of the American Medical Association. 299 (9): 1036–45. doi:10.1001/jama.299.9.1036. PMID 18319414.
^Tenny, Steven; Hoffman, Mary R. (2020), "Relative Risk", StatPearls, StatPearls Publishing, PMID 28613574, retrieved 2020-06-10
^ abMash, Eric J. (2019). Abnormal child psychology. Wolfe, David A. (David Allen), 1951- (Seventh ed.). Boston, MA. ISBN9781337624268. OCLC 1022139949.
^Pega, Frank; Nafradi, Balint; Momen, Natalie; Ujita, Yuka; Streicher, Kai; Prüss-Üstün, Annette; Technical Advisory Group (2021). "Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury". Environment International. 154: 106595. doi:10.1016/j.envint.2021.106595. ISSN 0160-4120. PMC8204267. PMID 34011457.
^Li G., Baker S. P., Qiang Y., Grabowski J. G., McCarthy M. L. Driving-while-intoxicated history as a risk marker for general aviation pilots. Accid Anal Prev. 2005;37(1):179-84./McFadden K. L. Driving while intoxicated (DWI) convictions and job-related flying performance – a study of commercial air safety. J Oper Res Soc. 1998;49:28–32
^Husten, Larry (23 August 2011). "William Kannel, Former Director of the Framingham Heart Study, Dead at 87". Forbes.
Further reading
S. P. Case and K. R. Haines, Understanding Youth Offending: Risk Factor Research, Policy and Practice, Willan, 2009.
April 03, 2023
risk, factor, this, article, about, concept, epidemiology, other, uses, disambiguation, this, article, needs, attention, from, expert, medicine, specific, problem, defining, determinant, complicated, poorly, harmonized, concept, medicine, some, sources, term, . This article is about the concept in epidemiology For other uses see Risk factor disambiguation This article needs attention from an expert in medicine The specific problem is defining determinant a complicated poorly harmonized concept in medicine Some sources use the term loosely while others use it as a technical term WikiProject Medicine may be able to help recruit an expert July 2019 In epidemiology a risk factor or determinant is a variable associated with an increased risk of disease or infection 1 38 Due to a lack of harmonization across disciplines determinant in its more widely accepted scientific meaning is often used as a synonym The main difference lies in the realm of practice medicine clinical practice versus public health As an example from clinical practice low ingestion of dietary sources of vitamin C is a known risk factor for developing scurvy Specific to public health policy a determinant is a health risk that is general abstract related to inequalities and difficult for an individual to control 2 3 4 For example poverty is known to be a determinant of an individual s standard of health Contents 1 Correlation vs causation 2 Terms of description 3 Example 4 General determinants 5 Risk marker 6 History 7 See also 8 References 9 Further readingCorrelation vs causation EditRisk factors or determinants are correlational and not necessarily causal because correlation does not prove causation For example being young cannot be said to cause measles but young people have a higher rate of measles because they are less likely to have developed immunity during a previous epidemic Statistical methods are frequently used to assess the strength of an association and to provide causal evidence for example in the study of the link between smoking and lung cancer Statistical analysis along with the biological sciences can establish that risk factors are causal Some prefer the term risk factor to mean causal determinants of increased rates of disease and for unproven links to be called possible risks associations etc citation needed When done thoughtfully and based on research identification of risk factors can be a strategy for medical screening 5 Terms of description EditMainly taken from risk factors for breast cancer risk factors can be described in terms of for example Relative risk such as A woman is more than 100 times more likely to develop breast cancer in her 60s than in her 20s 6 Fraction of incidences occurring in the group having the property of or being exposed to the risk factor such as 99 of breast cancer cases are diagnosed in women 7 Increase in incidence in the exposed group such as each daily alcoholic beverage increases the incidence of breast cancer by 11 cases per 1000 women 8 Hazard ratio such as an increase in both total and invasive breast cancers in women randomized to receive estrogen and progestin for an average of 5 years with a hazard ratio of 1 24 compared to controls 9 Example EditAt a wedding 74 people ate the chicken and 22 of them were ill while of the 35 people who had the fish or vegetarian meal only 2 were ill Did the chicken make the people ill R i s k number of persons experiencing event food poisoning number of persons exposed to risk factor food displaystyle Risk frac mbox number of persons experiencing event food poisoning mbox number of persons exposed to risk factor food 10 So the chicken eaters risk 22 74 0 297 And non chicken eaters risk 2 35 0 057 Those who ate the chicken had a risk over five times as high as those who did not that is a relative risk of more than five This suggests that eating chicken was the cause of the illness but this is not proof This example of a risk factor is described in terms of the relative risk it confers which is evaluated by comparing the risk of those exposed to the potential risk factor to those not exposed General determinants EditThe probability of an outcome usually depends on an interplay between multiple associated variables When performing epidemiological studies to evaluate one or more determinants for a specific outcome the other determinants may act as confounding factors and need to be controlled for e g by stratification The potentially confounding determinants varies with what outcome is studied but the following general confounders are common to most epidemiological associations and are the determinants most commonly controlled for in epidemiological studies citation needed Age 0 to 1 5 years for infants 1 5 to 6 years for young children etc Sex or gender Male or female 11 20 Ethnicity Based on race 11 21 Other less commonly adjusted for possible confounders include Social status income 1 39 Geographic location Genetic predisposition Gender identity Occupation Overwork 12 Sexual orientation Level of chronic stress Diet Level of physical exercise Alcohol consumption and tobacco smoking Other social determinants of healthRisk marker EditA risk marker is a variable that is quantitatively associated with a disease or other outcome but direct alteration of the risk marker does not necessarily alter the risk of the outcome For example driving while intoxicated DWI history is a risk marker for pilots as epidemiologic studies indicate that pilots with a DWI history are significantly more likely than their counterparts without a DWI history to be involved in aviation crashes 13 History EditThe term risk factor was coined by former Framingham Heart Study Director Dr William B Kannel in a 1961 article in Annals of Internal Medicine 14 See also EditHealth risk assessment High risk people Protective factor Social determinants of healthReferences Edit a b Parritz Robin Hornik 2017 05 24 Disorders of childhood development and psychopathology Troy Michael F Michael Francis Third ed Boston MA ISBN 9781337098113 OCLC 960031712 Improving Health in the Community A Role for Performance Monitoring 2 Understanding Health and Its Determinants A Model of the Determinants of Health National Academy of Sciences National Academies Press Institute of Medicine US Committee on Using Performance Monitoring to Improve Community Health 1997 ISBN 978 0309055345 Unlike a biomedical model that views health as the absence of disease this dynamic framework includes functional capacity and well being as health outcomes of interest It also presents the behavioral and biologic responses of individuals as factors that influence health but are themselves influenced by social physical and genetic factors that are beyond the control of the individual Health Impact Assessment HIA Glossary of terms used World Health Organization Retrieved July 20 2019 Health Impact Assessment HIA The determinants of health World Health Organization Archived from the original on May 30 2004 Retrieved July 20 2019 Wald N J Hackshaw A K Frost C D 1999 When can a risk factor be used as a worthwhile screening test BMJ 319 7224 1562 1565 doi 10 1136 bmj 319 7224 1562 ISSN 0959 8138 PMC 1117271 PMID 10591726 Margolese RG Fisher B Hortobagyi GN Bloomer WD 2000 Neoplasms of the Breast In Bast RC Kufe DW Pollock RE et al eds Cancer Medicine 5th ed Hamilton Ontario B C Decker Risk Factors ISBN 1 55009 113 1 Retrieved 27 January 2011 Giordano SH Cohen DS Buzdar AU Perkins G Hortobagyi GN July 2004 Breast carcinoma in men a population based study Cancer 101 1 51 7 doi 10 1002 cncr 20312 PMID 15221988 S2CID 972345 Allen NE Beral V Casabonne D et al March 2009 Moderate alcohol intake and cancer incidence in women Journal of the National Cancer Institute 101 5 296 305 doi 10 1093 jnci djn514 PMID 19244173 Heiss G Wallace R Anderson G L Aragaki A Beresford S A A Brzyski R Chlebowski R T Gass M Lacroix A 2008 Health Risks and Benefits 3 Years After Stopping Randomized Treatment with Estrogen and Progestin PDF JAMA The Journal of the American Medical Association 299 9 1036 45 doi 10 1001 jama 299 9 1036 PMID 18319414 Tenny Steven Hoffman Mary R 2020 Relative Risk StatPearls StatPearls Publishing PMID 28613574 retrieved 2020 06 10 a b Mash Eric J 2019 Abnormal child psychology Wolfe David A David Allen 1951 Seventh ed Boston MA ISBN 9781337624268 OCLC 1022139949 Pega Frank Nafradi Balint Momen Natalie Ujita Yuka Streicher Kai Pruss Ustun Annette Technical Advisory Group 2021 Global regional and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries 2000 2016 A systematic analysis from the WHO ILO Joint Estimates of the Work related Burden of Disease and Injury Environment International 154 106595 doi 10 1016 j envint 2021 106595 ISSN 0160 4120 PMC 8204267 PMID 34011457 Li G Baker S P Qiang Y Grabowski J G McCarthy M L Driving while intoxicated history as a risk marker for general aviation pilots Accid Anal Prev 2005 37 1 179 84 McFadden K L Driving while intoxicated DWI convictions and job related flying performance a study of commercial air safety J Oper Res Soc 1998 49 28 32 Husten Larry 23 August 2011 William Kannel Former Director of the Framingham Heart Study Dead at 87 Forbes Further reading EditS P Case and K R Haines Understanding Youth Offending Risk Factor Research Policy and Practice Willan 2009 Retrieved from https en wikipedia org w index php title Risk factor amp oldid 1132627175, wikipedia, wiki, book, books, library,
