“WEB OF CAUSATION”

Ns. Annisa Wuri Kartika, S.Kep.,M.Kep

Tujuan pembelajaran

Memahami penggunaan
Mampu membuat WOC
Memahami definisi WOC WOC dalam tahapan
dalam contoh kasus
analisa data
EPIDEMIOLOGY

 Study of the determinants and distribution of

health, disease and injuries in human
populations.
 The ultimate goals of epidemiology are to
determine the scale and nature of human
health problems, identify solutions to prevent
Stressor Malfunction

disease, and improve the health of the entire

population (Fos & Fine, 2000)
 To provide a basis for developing disease
control and prevention measures for groups Exposure Disease
at risk. This translates into developing Hypothesis: Do persons with exposure have
measures to prevent or control disease. higher levels of disease than persons without
exposure?
CAUSALITY ?
Relationship between a cause and its effect (Allender &
Spradley, 2005)
Chain of Causation
 Identifying the reservoir - portal of exit - mode of transmission – agent –
portal of entry – host
Multiple Causation
 Dever’s epidemiological model considers the health status of the host and
how it impacted by human biology, life-style, environment, and health care
system (Poremba, 2003)
 The term web of causality recognizes the complex
interrelationships of many factors interacting, sometimes in subtle
ways, to increase (or decrease) the risk for disease
“Web Of Causation” (MacMahon & Pugh, 1970)
Cont,…
 Issues to consider
 Etiology (cause) of chronic disease is often difficult to
determine
 Many exposures cause more than one outcome
 Outcomes may be due to a multiple exposures or continual
exposure over time
 Causes may differ by individual
 Causation and Association
 Epidemiology does not determine the cause of a disease in a given individual
 Instead, it determines the relationship or association between a given exposure
and frequency of disease in populations
 We infer causation based upon the association and several other factors
 Association  an identifiable relationship between an exposure and disease
 implies that exposure might cause disease
 exposures associated with a difference in disease risk are often called “risk
factors”
 Most often, we design interventions based upon associations
Cont, …
 Causation - implies that there is a true mechanism that
leads from exposure to disease
 Finding an association does not make it causal
How do we establish cause?

Exposure Disease

Additional Factors
Web of Causation
Web of Causation - CHD
 Hill’s Criteria for Causal Inference

Consistency of findings
Strength of association
Biological gradient (dose-response)
Temporal sequence
Biological plausibility
Coherence with established facts
Specificity of association