October 28, 2014

Absolute, relative, correlation, cause

The conclusions of a recent research paper

Delivery by [caesarean section] is associated with a modest increased odds of [autism], and possibly ADHD, when compared to vaginal delivery. Although the effect may be due to residual confounding, the current and accelerating rate of[caesarean section] implies that even a small increase in the odds of disorders, such as [autism] or ADHD, may have a large impact on the society as a whole. This warrants further investigation.

The Herald

Babies born through Caesarean section are more likely to develop autism, a new study says.

Academics warn the increasingly popular C-section deliveries heighten the risk of the disorder by 23 per cent.

There’s a fairly clear difference in language: the news story is fairly clearly implying that caesarean sections cause autism; the research paper is being scrupulously careful not to say that.

Using a relative risk is convenient in technical communication, but in non-technical communication makes the impact seem greater than it really is. The US Centers for Disease Control estimate a risk of 1 in 68 for autism spectrum disorder (there aren’t systematic NZ data).  If the correlation with C-section really is causal, we’re talking about roughly 14 kids with autism spectrum disorders per 1000 without a C-section and about 17 per 1000 with a C-section. The absolute risk increase, if it’s real, is about 3 cases per 1000 C-sections.

It’s also important to be clear that this correlation cannot explain much of the recent increases in autism. A relative risk of 1.23 means that if we went from no C-sections to 100% C-sections there would be a 23% increase in autism spectrum disorder. The observed increase is about five times that, and since  C-sections have only increased about 10 percentage points, not 100 percentage points, the observed increase in autism is about 50 times what this correlation could explain.

There are (I’m told by people who know the issues) good reasons to think there are too many C-sections.  This probably won’t be one of the most important ones.



Thomas Lumley (@tslumley) is Professor of Biostatistics at the University of Auckland. His research interests include semiparametric models, survey sampling, statistical computing, foundations of statistics, and whatever methodological problems his medical collaborators come up with. He also blogs at Biased and Inefficient See all posts by Thomas Lumley »