Assessing risk of bias in human environmental epidemiology studies using three tools: different conclusions from different tools.
Assessing risk of bias in human environmental epidemiology studies using three tools: different conclusions from different tools.
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DOI：
10.1186/s13643-020-01490-8
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发表时间：
2020-10-29
影响因子：
3.7
通讯作者：
Woodruff TJ
中科院分区：
文献类型：
--
作者：
Eick SM;Goin DE;Chartres N;Lam J;Woodruff TJ
系统评价在环境健康中越来越普遍，因为它们能够在减少偏见的同时合成证据。美国国家毒理学计划的健康评估和翻译办公室(OHAT)、美国环境保护局(EPA)的综合风险信息系统(IRIS)以及美国环保局根据《有毒物质控制法》(TSCA)开发了不同的系统审查方法，包括评估偏差风险(ROB)的方法，这是用于评估研究内部有效性的最重要步骤之一。我们的目标是比较三种工具(OHAT，IRIS，TSCA)在评估ROB方面的表现。我们选择了一篇关于多溴二苯醚与智商和/或注意缺陷多动障碍的系统综述，因为它已经得到了美国国家科学院的认可。两名评价者遵循工具的逐字说明，并独立地应用每个工具来评估先前确定的15项研究中的ROB。我们记录了应用每个工具的时间，以及每个工具的Rob评级对整个证据质量的最终评级的影响。完成ROB评估的时间差异很大(对于OHAT、IRIS和TSCA工具，平均每项研究分别为20、32和40 分钟)。使用IRIS，所有研究都被评为总体“低”或“缺乏信息”，这是由于在一个或两个领域的“不足”或“严重不足”。同样，所有使用TSCA工具的研究都被评为“不可接受”，因为在与统计能力相关的指标中，有一项是“不可接受的”。在使用OHAT和导航指南工具的所有领域中，大约有一半的研究对ROB的评级为“低”或“可能低”。使用总体ROB或研究质量评级的工具，如IRIS和TSCA，可能会错误地排除研究，从而减少可用于评估环境暴露危害的证据，从而导致对证据质量的不准确结论。我们建议使用ROB工具来规避这些问题，例如OHAT和导航指南。这项审查没有登记，因为它不是一项系统的审查。
Systematic reviews are increasingly prevalent in environmental health due to their ability to synthesize evidence while reducing bias. Different systematic review methods have been developed by the US National Toxicology Program’s Office of Health Assessment and Translation (OHAT), the US Environmental Protection Agency’s (EPA) Integrated Risk Information System (IRIS), and by the US EPA under the Toxic Substances Control Act (TSCA), including the approach to assess risk of bias (ROB), one of the most vital steps which is used to evaluate internal validity of the studies. Our objective was to compare the performance of three tools (OHAT, IRIS, TSCA) in assessing ROB. We selected a systematic review on polybrominated diphenyl ethers and intelligence quotient and/or attention deficit hyperactivity disorder because it had been endorsed by the National Academy of Sciences. Two reviewers followed verbatim instructions from the tools and independently applied each tool to assess ROB in 15 studies previously identified. We documented the time to apply each tool and the impact the ROB ratings for each tool had on the final rating of the quality of the overall body of evidence. The time to complete the ROB assessments varied widely (mean = 20, 32, and 40 min per study for the OHAT, IRIS, and TSCA tools, respectively). All studies were rated overall “low” or “uninformative” using IRIS, due to “deficient” or “critically deficient” ratings in one or two domains. Similarly, all studies were rated “unacceptable” using the TSCA tool because of one “unacceptable” rating in a metric related to statistical power. Approximately half of the studies had “low” or “probably low ROB” ratings across all domains with the OHAT and Navigation Guide tools. Tools that use overall ROB or study quality ratings, such as IRIS and TSCA, may reduce the available evidence to assess the harms of environmental exposures by erroneously excluding studies, which leads to inaccurate conclusions about the quality of the body of evidence. We recommend using ROB tools that circumvents these issues, such as OHAT and Navigation Guide. This review has not been registered as it is not a systematic review.