Concepts of Causation

of Diseases
Concept of Disease

A pathological condition of a part, organ, or

system of an organism resulting from various
causes, such as
infection, genetic defect, or environmental stress,
and
characterized by an identifiable group of signs or
symptoms
The Concept of Cause/s

 is an event, condition, characteristic or

combination of these factors - which produce
disease

 A cause is termed sufficient when it inevitably

produces or initiates disease

 It usually not a single factor but often

comprises of several components
Theories of Disease Causation
 Germ Teory
 Theory of Epidemiological Triad
 Multifactorial Causation Theory
 Web of Causation
 Devers Epidemiological Model
1. Germ Theory
 It becomes popular during the 19th and early part of
20th century.

 This theory attributes micro-organisms as the only

cause of disease.

Causitive agent Man Disease

Cause Effect
2. Theory of Epidemiological Triad

 This model is also called as ecological model

and evolved through the study of infectious
disease.

 agent, host & environment.

 agent

host environment
3. Multifactorial Causation Theory
 Disease caused by multiple factors .
example:- coronary heart disease.
 4. WEB OF CAUSATION

Given by macmohan and pugh.

• disease never depends upon single isolated

cause

• it develops from a chain of causation

• each link itself is a result of complex

interaction
5. Devers Epidemiological Model

 This model is composed of four major categories of

factors
 human biology
 lifestyle,
 environment and
 health system.
all these factors influence health status positively or
negatively.
General Model of Causation
3. Criteria For Causality:

1. Koch’s Postulates
2. Hills’ Criteria
3. Elwood’s Criteria
Koch’s Postulates: It states that:
1) A specific microorganism is always associated with a
given disease.
2) The microorganism can be isolated from the diseased
animal and grown in pure culture in the laboratory.
3) The cultured microbe will cause disease when
transferred to a healthy animal.
4) The same type of microorganism can be isolated
from the newly infected animal.
Hill’s Criteria of Causation:
(i) Strength of Association
(ii) Biological Gradient (Dose response relationship)
(iii) Temporal sequence
(iv) Consistency of findings
(v) Specificity of association
(vi) Coherence with established facts
(vii) Biological Plausibility
(viii) Experimental evidence
(i). Strength of Association:

Strong associations are less likely to be caused by

chance or bias.

A strong association is one in which the measure

or risk (RR, OR) is very high, or very low
(ii). Biological Gradient (Dose response):
There is evidence of a dose-response relationship.
Changes in exposure are related to a trend in risk
of disease
Standardized mortality ratios due to lung cancer
have increased with increasing numbers of
cigarette smoked per day in all the three studies
under reference.
(iii) Temporal Association:
Temporal association implies that exposure must
precede disease.
In diseases with latency periods, exposures must
precede the latent period.
Chronic diseases, often need long-term exposure
for disease induction.
(iv) Consistency of findings:
Relationships that are demonstrated in multiple
studies are more likely to be causal
Look for consistent findings
 in same direction (risk/protection)

 across different populations

 in differing circumstances

 with different study designs

(v) Specificity of association:
An exposure leads to a single or characteristic
effect, or affects people with a specific
susceptibility.
It is easier to support causation when associations
are specific, but this may not always be the
case.
Many exposures cause multiple diseases
(vi). Coherence with established facts:
Causal mechanism must not contradict what is
known about the natural history and biology of
the disease, yet
 the relationship may be indirect

 data may not be available to directly support the

proposed mechanism
 must be prepared to reinterpret existing
understanding of disease in the face of new
findings
(vii). Biological plausibility:
The proposed causal mechanism can be explained
biologically
 in animal models

 in laboratory
(viii). Experimental evidence:
 Direct observation in laboratory or animal

models
 Protective factors should be tested in
experimental designs
RCT, Community Trials.
Experimental evidence is the Gold standard of
evidence
Elwood's criteria of causality:

It requires understanding of…………

descriptive evidence,

non casual explanation,

generalisability and

comparison with other evidence

Elwood's criteria of causality:
Casual inference
 No single study is sufficient to deduce causal
inference

Causal inference is not a simple process:

 Consider weight of evidence

 requires judgment and interpretation

 Casual inference
 No way to prove causal associations for most
chronic diseases and conditions
 All associations may not be causal

 Results obtained should be judged using criteria

of causality and likelihood of errors

 Most judgments of cause and effect are

tentative, and are open to change with new

evidence.
Dynamics of Disease Transmission

 Communicable diseases are transmitted from the

reservoir/ source of infection to susceptible host.

 There are three links in the chain of transmission

 Reservoir
 Mode of transmission
 Susceptible host
 SOURCE SUSCEPTIBLE
MODE OF
OR HOST
TRANSMISSION
RESERVOIR
Types of reservoir

1. Human reservoir – case, carrier

2. Animal reservoir

3. Reservoir in non living things

 • 1. Droplet contact
A. DIRECT • 2. Droplet infection
• 3. Contact with soil
TRANSMISSIO • 4. Inoculation into skin or
N mucosa
• 5. Trans placental

• 1. Vehicle borne
B. INDIRECT • 2. Vector borne
• 3. Air borne
TRANSMISSIO • 4. Fomite borne
N • 5. Unclean hands and fingers
SUCCESSFUL PARASITISM
 4 stages are there in successful parasitism

SURVIVAL
PORTAL OF SITE OF PORTAL OF IN THE
ENTRY ELECTION EXIT ENVORNME
NT
Natural History of Disease
It signifies the way in which a disease
evolves over time

from earliest stage of its prepathogenesis to

its termination as recovery, disability or
death, in the absence of treatment or
prevention
 Spectrum of Disease and
Iecberg Phenomenon

 The severity and extent of disease in the

individual passes through various stages and is
signified by the term “spectrum of disease”.

 It is the sequence of events that occur in the

human organism from the time of exposure to
the etiological agent till death.

 It is composed of sub-clinical and clinical

components.
 Doctors are usually aware of a small part
of the spectrum of disease (usually
clinically apparent)

 which is proverbially known as the tip of

the iceberg.
 Spectrum of Disease and
Iecberg Phenomenon

Whether an individual with the disease progresses

through the entire spectrum ?
depends on the availability and efficacy of
preventive and therapeutic measures,

Which, if introduced at a particular point of the

spectrum,
will completely prevent or retard any further
development of the disease