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Causal and Associational Language in Observational Health Research: A Systematic Evaluation

2022/08/04 by Noah Haber, Sarah Wieten, Julia M. Rohrer +46 · 2 voices · 1 citation
Computer Science · Health Professions · Mathematics · #Advanced Causal Inference Techniques #Bayesian Modeling and Causal Inference #Health Policy Implementation Science

paper · pdf · doi:10.1093/aje/kwac137

openalex publication_date 2022/08/04 · openalex created_date 2025/10/10 · openalex updated_date 2026/07/28

Abstract

We estimated the degree to which language used in the high-profile medical/public health/epidemiology literature implied causality using language linking exposures to outcomes and action recommendations; examined disconnects between language and recommendations; identified the most common linking phrases; and estimated how strongly linking phrases imply causality. We searched for and screened 1,170 articles from 18 high-profile journals (65 per journal) published from 2010-2019. Based on written framing and systematic guidance, 3 reviewers rated the degree of causality implied in abstracts and full text for exposure/outcome linking language and action recommendations. Reviewers rated the causal implication of exposure/outcome linking language as none (no causal implication) in 13.8%, weak in 34.2%, moderate in 33.2%, and strong in 18.7% of abstracts. The implied causality of action recommendations was higher than the implied causality of linking sentences for 44.5% or commensurate for 40.3% of articles. The most common linking word in abstracts was "associate" (45.7%). Reviewers' ratings of linking word roots were highly heterogeneous; over half of reviewers rated "association" as having at least some causal implication. This research undercuts the assumption that avoiding "causal" words leads to clarity of interpretation in medical research.

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