Hill's Considerations for Causal Inference

Carl V. Phillips & Karen J. Goodman

Austin Bradford Hill's widely cited list of considerations, from his 1965 address to the Royal Society of Medicine, presents factors to consider before inferring causation from an observed association. This list is often erroneously referred to as the ‘Bradford Hill criteria’ or ‘causal criteria,’ although any list that lacks a basis for determining whether a condition is met, or for compiling such determinations to draw an overall conclusion, does not constitute a set of criteria, and Hill warns in the address that there are no ‘hardand-fast rules of evidence’ for causation (Hill, 1965, p. 299). This widespread misinterpretation is particularly unfortunate because it distracts from lessons in Hill's address that ‘offer ways to dramatically increase the contribution of health science’—for example, systematic error is often more important than random error; decisions must always be made using the epidemiologic evidence that exists; weighing costs and benefits matters more than statistical significance ...

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