Hill's criteria

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Hill’s criteria are useful for evaluating whether an (environmental) association is likely to be causal. Most statistical associations will not be causal.

  • Strength
    • What is the degree to which the exposure is associated with the outcome ?
  • Consistency
    • Has the association been repeatedly observed by different persons, in different places, circumstances, and times ?
  • Specificity
    • Is the observed association limited to the exposure and outcome?
  • Temporality
    • Does a particular intervention lead to disease or do early stages of disease lead to those with the disease undertaking a particular confounding intervention
  • Biologic gradient
    • Is there a dose–response relationship between the exposure and outcome?
  • Plausibility
    • Is there a physiological basis for the observed association?
  • Coherence
    • Does the “cause-and-effect interpretation” of the association “seriously conflict” with “generally known facts about the natural history and biology of the disease”?
  • Experiment
    • Is the frequency of associated events [outcomes] affected by actions to prevent the exposure?
  • Analogy
    • Does an exposure with a similar action (physiologically) cause the outcome?

Adapted from Hill[1]


  1. Hill AB. The environment and disease: association or causation? Proc R Soc Med 1965;58:295-300