Influence of exposure assessment methods on risk estimates in an epidemiologic study of total trihalomethane exposure and spontaneous abortion
Influence of exposure assessment methods on risk estimates in an epidemiologic study of total trihalomethane exposure and spontaneous abortion
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总三卤甲烷暴露和自然流产流行病学研究中暴露评估方法对风险估计的影响
DOI：
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发表时间：
2001
期刊：
影响因子：
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通讯作者：
L. Fenster
中科院分区：
文献类型：
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作者：
K. Waller;S. Swan;G. Windham;L. Fenster
三卤甲烷是氯化饮用水的常见污染物。其健康影响的研究一直受到影响的暴露分类错误，部分原因是固有的限制，在使用公用事业抽样记录。我们使用了两种暴露评估方法，一种是基于公用事业范围内的抽样平均值，另一种是基于距离受试者住所最近的公用事业抽样点的测量值，重新估计了4212名参与者在先前存在的自然流产（SAB）风险因素研究中的总三卤甲烷（TTHM）暴露。对于这两种方法，我们进行了未加权，加权和子集分析。加权和子集分析旨在减少暴露错误分类，并基于公用事业范围内的TTHM测量值的平均值方法的公用事业内方差，以及受试者的住所和采样点之间的距离最近的网站的方法。一般来说，公用事业范围内的平均方法产生的优势比等于或略高于最近的网站的方法。使用公用事业范围内的平均值，而不是最近的网站，方法获得的比值比也变得越来越强的加权和子集分析。剂量反应之间的SAB和暴露度量结合TTHM浓度（公用事业范围内的平均方法）和个人摄入，与SAB率范围从8.3%到13.7%（未加权），7.9%到16.6%（方差加权），6.6%到23.1%（低方差子集）。公用事业平均TTHM暴露评估方法与基于方差的权重和子集是相对简单的暴露评估技术，这可能会增加公用事业抽样记录的流行病学有用性。
Trihalomethanes are common contaminants of chlorinated drinking water. Studies of their health effects have been hampered by exposure misclassification, due in part to limitations inherent in using utility sampling records. We used two exposure assessment methods, one based on utility-wide sampling averages, and one based on measurements from the utility sampling site closest to the subject's residence, to reestimate total trihalomethane (TTHM) exposure for 4212 participants in a preexisting study of risk factors for spontaneous abortion (SAB). For both approaches we performed unweighted, weighted, and subset analyses. The weighted and subset analyses were intended to reduce exposure misclassification, and were based on within-utility variance in TTHM measurements for the utility-wide average approach, and the distance between the subject's residence and sampling site for the closest-site approach. In general, the utility-wide average methods produced odds ratios equivalent to or slightly higher than the closest-site methods. Odds ratios obtained using the utility-wide average, but not the closest-site, approach also became progressively stronger in the weighted and subset analyses. A dose–response was seen between SAB and an exposure metric incorporating both TTHM concentration (utility-wide average approach) and personal ingestion, with SAB rates ranging from 8.3% to 13.7% (unweighted), 7.9% to 16.6% (variance weighted), and 6.6% to 23.1% (low-variance subset). Utility-wide average TTHM exposure assessment methods together with variance-based weights and subsets are relatively simple exposure assessment techniques, which may increase the epidemiologic usefulness of utility sampling records.