International Journal of Epidemiology 2002;31:166-167
© International Epidemiological Association 2002
Theory and Methods |
Commentary: Estimating direct and indirect effects—fallible in theory, but in the real world?
Department of Public Health, Wellington School of Medicine, University of Otago, PO Box 7343, Wellington, New Zealand. E-mail: tblakely@wnmeds.ac.nz
A classic finding of the Whitehall Study was that only a third of the association of occupational grade (a socioeconomic ranking of occupations within the British civil service) with coronary heart disease mortality was ‘explained’ after adjusting for known cardiovascular risk factors.1 In current terminology, a third of the association of socioeconomic position with coronary heart disease mortality was estimated as ‘indirect’ via known risk factors, and two-thirds (that unexplained) was estimated as ‘direct’. This direct effect, it is assumed (e.g. ref. 2), represents the mediating or indirect effects of other factors (e.g. unmeasured and/or unknown dietary and lifestyle behaviours, psychosocial factors). For example, subsequent research on the Whitehall Study
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