This chapter distinguishes between predictive models of disease risk and causal models, a distinction that is important since several predictive factors may be the result of unrecognized or undiagnosed disease. Causal risk factors must necessarily be antecedent to the onset of the disease they cause. Three further distinctions in the risk factors that are antecedent to disease should also be noted, namely, distal, proximal, and ultimate factors. Distal risk factors are those that are in place long before the disease process is known to begin. Proximal risk factors are those to which exposure occurs closer in time to disease onset. Finally, ultimate causal risk factors are those that provide the tipping point for the initiation of the final disease process.
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