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Establishing a causal link between social relationships and health using the Bradford Hill Guidelines.

ABSTRACT: An abundance of evidence suggests that the size and quality of our social relationships improves humans' physical and mental health while increasing lifespan. However most of this evidence comes from observational rather than experimental (randomised trial) evidence, leaving open the possibility that the connection between social relationships and health could be associational rather than causal. However there are examples, including the link between smoking and lung cancer, where a cause was established without experimental evidence. This was sometimes achieved by looking at the totality of evidence, using the 'Bradford Hill Guidelines', which considers factors including the strength of association, reversibility, and evidence of a plausible mechanism. In this paper we apply the Bradford Hill Guidelines to the link between social relationships and health. We conclude that having strong and supportive social relationships causes better health and longer life. Beyond establishing that social relationships are a causal factor for health, the method we used here can be applied to other areas where randomised trials are unethical or not feasible.

SUBMITTER: Howick J

PROVIDER: S-EPMC6527915 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Establishing a causal link between social relationships and health using the Bradford Hill Guidelines.

Howick Jeremy J Kelly Paul P Kelly Mike M

SSM - population health 20190504

An abundance of evidence suggests that the size and quality of our social relationships improves humans' physical and mental health while increasing lifespan. However most of this evidence comes from observational rather than experimental (randomised trial) evidence, leaving open the possibility that the connection between social relationships and health could be associational rather than causal. However there are examples, including the link between smoking and lung cancer, where a cause was es ...[more]

PMID: 31193417

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Project description:BackgroundPsychological stress is a prevalent factor in inflammatory bowel disease (IBD) with detrimental effects on patients' quality of life and possibly disease course. Although the aetiology of symptom exacerbation in IBD has been explored, determining any causation between psychological stress and symptom worsening remains challenging and requires a methodologically rigorous approach.AimThe aim of this systematic review with meta-analysis was to determine a causal relationship between psychological stress and symptom exacerbation in IBD, subsequently utilising Bradford Hill's criteria (approach never used in this topic area before) to evaluate the likelihood of causal associations.MethodsMedline, EMBASE, CINAHL and PsycInfo were searched for relevant studies up to July 20, 2019. Data extraction and quality appraisal were performed by two independent reviewers. Results of all retained papers were presented as a narrative synthesis. A random-effect meta-analysis was conducted on studies meeting the criteria for meta-analysis. Bradford Hill criteria were applied to assess the causality of the relationship between all psychological factors and symptom exacerbation.ResultsThe searches yielded 2472 potential articles. Nineteen clinical prospective cohort studies were eligible for the narrative review with five suitable for the meta-analysis. Meta-analysis showed depression, anxiety and perceived stress did not have a statistically significant association with an increased risk of symptom exacerbation. Four of the Bradford Hill criteria were met which indicates that there is weak to moderate evidence of a causal association between all the psychological factors and disease activity. Inconsistent results and a dearth of studies using the same tools for measuring psychological factors suggest the need for more research to be done to facilitate more conclusive findings.ConclusionsThis original review utilising Bradford Hill criteria in addition to meta-analysis to evaluate the causality of relationship between psychological factors and symptom exacerbation in IBD provides evidence that psychological factors have a weak to moderate causal involvement in IBD symptom exacerbation. However, when combining this finding with the outcomes of the meta-analysis, we can say that the results were inconclusive. Interventions to reduce the associated psychological impact should be part of the treatment plan for patients with IBD.Systematic review registrationPROSPERO CRD42012003143.

Project description:ObjectiveWe aimed to investigate the causal relationships between social isolation and osteoarthritis.MethodsPublicly available genome-wide association study (GWAS) summary statistics of social isolation and osteoarthritis in European population were obtained from the Neale lab Consortium and the Medical Research Council-Integrative Epidemiology Unit (MRC-IEU) consortium, respectively. Single nucleotide polymorphisms (SNPs) associated with the traits were identified by P < 5×10-8 and linkage disequilibrium r2 < 0.1. Three Mendelian randomization (MR) methods including the inverse-variance weighted (IVW) method, weighted median estimator, and MR-Egger regression were used to assess the potential causal effect of social isolation on osteoarthritis and the potential causal effect of osteoarthritis on social isolation. Leave-one-out analysis and test of directional horizontal pleiotropy via MR-Egger regression were performed as sensitivity analyses.ResultsWhen evaluating the causal effect of social isolation on osteoarthritis, five SNPs (rs12364432, rs13291079, rs2352075, rs4958586, rs599550) significantly associated with social isolation were studied as instruments, and social isolation was found to be causally associated with increased risk of osteoarthritis (odds ratio [OR] 1.197 (95% confidence interval (CI) 1.096-1.308) estimated by the IVW method). When evaluating the causal effect of osteoarthritis on social isolation, six SNPs (rs10405617, rs12133235, rs13107325, rs2290573, rs3771501, rs75621460) significantly associated with osteoarthritis were studied as instruments but no causal effect of osteoarthritis on social isolation was found (OR 1.104 (95% CI 0.887-1.375) estimated by the IVW method). Consistent causal relationships were observed when estimated by the weighted median estimator and MR-Egger regression. Leave-one-out analysis and test of directional horizontal pleiotropy suggested the robustness of the above findings.ConclusionSocial isolation is causally associated with osteoarthritis, and further work is needed to investigate the potential mechanisms.

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Establishing a causal link between social relationships and health using the Bradford Hill Guidelines.

Publications

Establishing a causal link between social relationships and health using the Bradford Hill Guidelines.

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