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Angrist JD, Krueger AB, 2001. Instrumental variables and the search for identification: from supply and demand to natural experiments. J Econ Perspect 15: 69–85.
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Valle D, Clark J, 2013. Conservation efforts may increase malaria burden in the Brazilian Amazon. PLoS One 8: e57519.
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A Cautionary Tale Regarding the Use of Causal Inference to Study How Environmental Change Influences Tropical Diseases
Denis Valle
Denis Valle
School of Forest Resources and Conservation, University of Florida, Gainesville, Florida;
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Gabriel Zorello Laporta
Gabriel Zorello Laporta
Setor de Pós-graduação, Pesquisa e Inovação, Centro Universitário Saúde ABC, Fundação ABC, Santo André, Brazil
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Abstract.
There has been substantial interest on the effect of large-scale environmental change, such as deforestation, on human health. An important and relatively recent development has been the use of causal-inference approaches (e.g., instrumental variables [IVs]) to more properly analyze this type of observational data. Here, we discuss an important study that attempted to disentangle the effect of malaria on deforestation from the effect of deforestation on malaria using an IV approach. The authors found that deforestation increases malaria (e.g., they estimate that a 10% increase in deforestation leads to a 3.3% increase in malaria incidence) through ecological mechanisms, whereas malaria reduces deforestation through socioeconomic mechanisms. An important characteristic of causal-inference approaches is that they are critically dependent on the plausibility of the underlying assumptions and that, differently from standard statistical models, many of these assumptions are not testable. In particular, we show how important assumptions of the IV approach adopted in the study described earlier were not met and that, as a result, it is possible that the correct conclusion could have been the opposite of that reported by the authors (e.g., deforestation decreases, rather than increasing, malaria through ecological mechanisms). Causal-inference approaches may be critical to characterize the relationship between environmental change and disease risk, but conclusions based on these methods can be even more unreliable than those from traditional methods if careful attention is not given to the plausibility of the underlying assumptions.
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Author Notes
Authors’ addresses: Denis Valle, School of Forest Resources and Conservation, University of Florida, Gainesville, FL, E-mail: drvalle@ufl.edu. Gabriel Zorello Laporta, Setor de Pós-graduação, Centro Universitário Saúde ABC, Santo André, Brazil, E-mail: gabriel.laporta@fmabc.br.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Tollefson J, 2020. Why deforestation and extinctions make pandemics more likely. Nature 584: 175–176.
-
2.
Gibb R, Redding DW, Chin KQ, Donnelly CA, Blackburn TM, Newbold T, Jones KE, 2020. Zoonotic host diversity increases in human-dominated ecosystems. Nature 584: 392–402.
-
3.
Dobson AP et al. 2020. Ecology and economics for pandemic prevention. Science 369: 379–381.
-
4.
PAHO, 2012. Chapter 3: the environment and human security. Health in the Americas, 2012. Washington, DC: Pan American Health Organization.
-
5.
PAHO, 2017. Suriname. Health in the Americas, 2017. Summary: Regional Outlook and Country Profiles. Washington, DC: Pan American Health Organization.
-
6.
Pearce N, Vandenbroucke JP, Lawlor DA, 2019. Causal inference in environmental epidemiology: old and new approaches. Epidemiology 30: 311–316.
-
7.
MacDonald AJ, Mordecai EA, 2019. Amazon deforestation drives malaria transmission, and malaria burden reduces forest clearing. Proc Natl Acad Sci U S A 116: 22212–22218.
-
8.
Pearl J, 2009. Causal inferece in statistics: an overview. Stat Surv 3: 96–146.
-
9.
Angrist JD, Krueger AB, 2001. Instrumental variables and the search for identification: from supply and demand to natural experiments. J Econ Perspect 15: 69–85.
-
10.
Baiocchi M, Cheng J, Small DS, 2014. Instrumental variable methods for causal inference. Stat Med 33: 2297–2340.
-
11.
Burke M, Hsiang SM, Miguel E, 2015. Global non-linear effect of temperature on economic production. Nature 527: 235–239.
-
12.
Valle D, Clark J, 2013. Conservation efforts may increase malaria burden in the Brazilian Amazon. PLoS One 8: e57519.
| Past two years | Past Year | Past 30 Days | |
|---|---|---|---|
| Abstract Views | 1268 | 488 | 110 |
| Full Text Views | 577 | 154 | 1 |
| PDF Downloads | 256 | 25 | 1 |