Use and Reliability of Exposure Assessment Methods in Occupational Case–Control Studies in the General Population: Past, Present, and Future

Ge, Calvin; Friesen, Melissa C.; Kromhout, Hans; Peters, Susan; Rothman, Nathaniel; Lan, Qing; Vermeulen, Roel

doi:10.1093/annweh/wxy080

Cited by 27 publications

(29 citation statements)

References 67 publications

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“…Yet a large percentage of documented EAM comprised self-reported exposures, to a high degree applied in studies on self-reported outcomes and cancer, which, particularly in case-control settings, might indicate a large potential of differential misclassification and responder bias. In agreement with Ge et al 36 we registered an increase in the use of self-reports by questionnaires as of the 1990s until end 2017. Although self-reports usually offer a convenient approach for assessing exposure at the individual level,36 the validity of self-reported exposures regarding lifelong use of pesticides is questionable and variable.…”

Section: Discussionsupporting

confidence: 92%

“…In agreement with Ge et al 36 we registered an increase in the use of self-reports by questionnaires as of the 1990s until end 2017. Although self-reports usually offer a convenient approach for assessing exposure at the individual level,36 the validity of self-reported exposures regarding lifelong use of pesticides is questionable and variable. As the validity of self-reports per se depends on the applicators’ knowledge of the applied pesticides, self-reported exposures by farmers knowing which active ingredients were used15 37 will be less prone to misclassification compared with hired farm workers or re-entry workers reporting on their pesticide exposure.…”

Section: Discussionsupporting

confidence: 92%

“…Our review further showed a low relative frequency of exposure algorithms and deterministic models, with no distinct time trend regarding the use of these. This result contradicts the work by Ge et al , who saw an increase in the use of algorithms, although they only considered cancer case-control studies 36…”

Section: Discussioncontrasting

confidence: 86%

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Systematic review of methods used to assess exposure to pesticides in occupational epidemiology studies, 1993–2017

et al. 2020

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ObjectiveNumerous exposure assessment methods (EAM) exist for investigating health effects of occupational exposure to pesticides. Direct (eg, biomonitoring) and indirect methods (eg, self-reported exposures) are however associated with degrees of exposure misclassification. We systematically reviewed EAM in studies of occupational pesticide exposure.MethodsWe searched for articles reporting observational epidemiological studies in MEDLINE and Embase published 1993 to 2017. The relative frequency of EAM was analysed according to EAM type (direct and indirect methods), health outcome, study design, study location (country) and specificity of assessment. Temporal trends in EAM were analysed.ResultsIn 1298 included articles 1521 EAM occurrences were documented. Indirect EAM (78.3%), primarily self-reported exposures (39.3%) and job titles assessments (9.5%), were mainly applied in case-control studies (95.0%), in high-income countries (85.0%) and in studies of doctor-diagnosed health outcomes (>85%). Direct EAM (20.8%), primarily biomonitoring of blood (15.6%) or urine (4.7%), were predominantly applied in cross-sectional studies (29.8%), in lower middle-income countries (40.9%) and in studies of neurological (50.0%) outcomes. Between 1993 to 2017 no distinct time trends regarding the ratio indirect to direct methods was seen. Within the category of indirect methods use of self-reported exposures and job exposure matrices increased while assessments by job titles and registers decreased. The use of algorithms showed no trend. The specificity of pesticide assessment increased since studies assessing exposure by using job title as a proxy declined. Assessments of type of pesticide increased.ConclusionOver the last 25 years, the ratio (5:1) of indirect to direct EAM applied in articles on occupational pesticide epidemiology stayed relatively constant; changes were mainly attributable to increasing use of self-reported exposures and job exposure matrices. This review, combined with studies assessing EAM validity, will inform on magnitudes of exposure misclassification and help improve the quality of studies on occupational pesticides exposure.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

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Systematic review of methods used to assess exposure to pesticides in occupational epidemiology studies, 1993–2017

et al. 2020

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“…The strengths of this study include a large number of exposed cases, a measurement-calibrated WEM, and adjustment for or stratification by smoking. Aside from the general limitations of the population-based case-control design with many "occasional" welders, the lack of individual and historical measurements can lead to misclassification when using job-exposure matrices (29,30). In this study, welding was performed before the 1990s, whereas measurements were available only after the 1990s.…”

Section: Discussionmentioning

confidence: 99%

Exposure to Welding Fumes, Hexavalent Chromium, or Nickel and Risk of Lung Cancer

Pesch¹,

Kendzia²,

Pohlabeln³

et al. 2019

American Journal of Epidemiology

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To investigate the risk of lung cancer after exposure to welding fumes, hexavalent chromium (Cr(VI)), and nickel, we analyzed 3,418 lung cancer cases and 3,488 controls among men from 2 German case-control studies (1988–1996). We developed a welding-process exposure matrix from measurements of these agents, and this was linked with welding histories from a job-specific questionnaire to calculate cumulative exposure variables. Logistic regression models were fitted to estimate odds ratios with confidence intervals conditional on study, and they adjusted for age, smoking, and working in other at-risk occupations. Additionally, we mutually adjusted for the other exposure variables under study. Overall, 800 cases and 645 controls ever worked as regular or occasional welders. Odds ratios for lung cancer with high exposure were 1.55 (95% confidence interval (CI): 1.17, 2.05; median, 1.8 mg/m3 × years) for welding fumes, 1.85 (95% CI: 1.35, 2.54; median, 1.4 μg/m3 × years) for Cr(VI), and 1.60 (95% CI: 1.21, 2.12; median, 9 μg/m3 × years) for nickel. Risk estimates increased with increasing cumulative exposure to welding fumes and with increasing exposure duration for Cr(VI) and nickel. Our results showed that welding fumes, Cr(VI), and nickel might contribute independently to the excess lung cancer risk associated with welding. However, quantitative exposure assessment remains challenging.

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“…Despite this difference, results of both analyses showed consistent exposure-response relationships between occupational exposure to diesel exhaust and lung cancer. Reliability studies on occupational exposure assessment also suggested that incorporating measurements in the exposure assessment process may improve expert judgment (Ge et al, 2018;Teschke et al, 2002). Finally, the exposure-response relationship between EC exposure and lung cancer in our male population was robust and present in various sensitivity analyses, including when we limited analyses to a more homogeneous group of studies, when we limited our analyses to blue-collar workers only, and when we assessed EC exposure with alternative JEM configurations (Supplementary .…”

Section: Discussionmentioning

confidence: 75%

Occupational exposure assessment in the general population: improvements, innovations, and impact

Ge¹

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Chapter 1 | General Introduction 1 there is an added benefit of being able to include more cases in the study, which allows the study of rare diseases, disease subtypes or uncommon pre-clinical conditions as health endpoints. Due to large sample sizes, population-based studies are well suited to investigate more complex issues surrounding exposure and disease, such as the effect of confounding and interactions between multiple exposures, as well as the exploration of novel exposure-disease associations.Naturally, population-based studies are not without disadvantages. One of the most significant limitations is the difficulty in assessing occupational exposure in population-based studies, as exposure may originate from a variety of workplaces and different time periods. If population-based studies are unable to accurately quantify disease risks associated with a unit of exposure, their utility and impact become limited in risk assessment and policymaking. The following chapters in this thesis aim to review, explore, and discuss potential means of improving exposure assessment and disease risk quantification in population-based studies.Chapter 2 is a systematic literature review on occupational exposure assessment approaches used in population-based case-control studies on carcinogens in the previous four decades. The review explores the reliability performance of assessment approaches and highlights important areas of new development.Chapter 3 demonstrates the performance of a real-time, algorithmic approach in assigning flexible, modular questionnaires during work history interviews in order to gather exposure information related to specific tasks. The manuscript covered the evaluation of a set of interview algorithms applied in 11,409 jobs episodes from subjects from the AsiaLymph project, which is a large, multi-centered hospital-based case-control study on lymphoma and leukemia in Asia.Chapter 4 describes the procedure, training, and coordination employed to complete the occupational coding for 34,353 jobs from 12,590 subjects in the AsiaLymph project and assesses the reliability performance in job coding work performed by different coders. The reliability performance of exposure assessment resulting from the different sets of job codes is further explored for different exposures via a generic job-exposure matrix.Chapter 5 estimates the association between occupational benzene exposure and risks of lymphohaematopoietic cancers in the Swiss National Cohort, which is a censusbased cohort of 2.97 million Swiss citizens with 13,415 lymphohaematopoietic cancer cases. The study serves to demonstrate that registry-based cohorts in the general population can be useful for investigating the relationships between workplace exposures and human diseases, particularly for rare disease subtypes.

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Use and Reliability of Exposure Assessment Methods in Occupational Case–Control Studies in the General Population: Past, Present, and Future

Cited by 27 publications

References 67 publications

Systematic review of methods used to assess exposure to pesticides in occupational epidemiology studies, 1993–2017

Systematic review of methods used to assess exposure to pesticides in occupational epidemiology studies, 1993–2017

Exposure to Welding Fumes, Hexavalent Chromium, or Nickel and Risk of Lung Cancer

Occupational exposure assessment in the general population: improvements, innovations, and impact

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