Identification of causal effects in case-control studies

BMC Med Res Methodol. 2022 Jan 7;22(1):7. doi: 10.1186/s12874-021-01484-7.

Abstract

Background: Case-control designs are an important yet commonly misunderstood tool in the epidemiologist's arsenal for causal inference. We reconsider classical concepts, assumptions and principles and explore when the results of case-control studies can be endowed a causal interpretation.

Results: We establish how, and under which conditions, various causal estimands relating to intention-to-treat or per-protocol effects can be identified based on the data that are collected under popular sampling schemes (case-base, survivor, and risk-set sampling, with or without matching). We present a concise summary of our identification results that link the estimands to the (distribution of the) available data and articulate under which conditions these links hold.

Conclusion: The modern epidemiologist's arsenal for causal inference is well-suited to make transparent for case-control designs what assumptions are necessary or sufficient to endow the respective study results with a causal interpretation and, in turn, help resolve or prevent misunderstanding. Our approach may inform future research on different estimands, other variations of the case-control design or settings with additional complexities.

Keywords: Case-control designs; Causal inference; Identifiability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Case-Control Studies
  • Causality
  • Humans
  • Models, Statistical*