Assessment of Biological Interactions Between Multiple Sclerosis Status and Depression for Mortality

Interaction is a word with a history in the literature.1 At its core, it is the idea that the effect of a factor (exposed) compared to a reference for that factor (not exposed) may depend on the presence of another factor.2 A classic textbook example includes smoking status and asbestos exposure on the risk of lung cancer. Each by itself increases the risk of lung cancer, but when someone has both risk factors, the incidence of lung cancer is far more than the sum of the increases in incidence from either. Distinct perspectives for an interaction have been delineated within specific disciplines, including statistical, epidemiologic, biological, and public health interactions.1 The choice of interactions used should be motivated by the goal of the analysis and what we are trying to learn.3

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