Testing the dose-response specification in epidemiology: Public health and policy consequences for lead
Testing the dose-response specification in epidemiology: Public health and policy consequences for lead
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DOI：
10.1289/ehp.7691
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发表时间：
2005-09-01
影响因子：
10.4
通讯作者：
Rothenberg, JC
中科院分区：
文献类型：
--
作者：
Rothenberg, SJ;Rothenberg, JC
在铅流行病学的剂量反应函数的统计评价很少尝试。对减少铅的健康效益的经济评估通常假设线性剂量反应函数，而不管使用的结果测量。我们重新分析了以前发表的一项研究，这是一项国际汇总数据集，结合了7项前瞻性铅研究的数据，这些研究检查了7岁儿童（n = 1，333）的同期血铅对智商（智商）的影响。我们构建了替代线性多元回归模型与线性血铅项（线性线性剂量反应）和自然对数转换的血铅项（对数线性剂量反应）。我们测试了两种电极导线规格在模型中的非线性，比较了两种电极导线规格与数据的拟合程度，并检查了可能的残留混杂对剂量-反应关系函数形式的影响。我们发现对数-线性导联-IQ关系比IQ的线性-线性关系拟合得更好（p = 0.009），几乎没有证据表明包含的模型变量存在残留混杂。我们在先前发表的健康效益模型中替换了对数线性铅-智商效应，发现1976年至1999年美国人口铅含量下降（从17.1 μ g/dL降至2.0 μ g/dL）所带来的经济节省是使用线性-线性剂量反应函数计算的（1490亿美元）的2.2倍（3190亿美元）。疾病控制和预防中心对儿童的行动限制为10微克/分升，这不能防止铅暴露造成的大部分损害和经济损失。
Statistical evaluation of the dose-response function in lead epidemiology is rarely attempted. Economic evaluation of health benefits of lead reduction usually assumes a linear dose-response function, regardless of the outcome measure used. We reanalyzed a previously published study, an international pooled data set combining data from seven prospective lead studies examining contemporaneous blood lead effect on IQ (intelligence quotient) of 7-year-old children (n = 1,333). We constructed alternative linear multiple regression models with linear blood lead terms (linear-linear dose response) and natural-log-transformed blood lead terms (log-linear dose response). We tested the two lead specifications for nonlinearity in the models, compared the two lead specifications for significantly better fit to the data, and examined the effects of possible residual confounding on the functional form of the dose-response relationship. We found that a log-linear lead-IQ relationship was a significantly better fit than was a linear-linear relationship for IQ (p = 0.009), with little evidence of residual confounding of included model variables. We substituted the log-linear lead-IQ effect in a previously published health benefits model and found that the economic savings due to U.S. population lead decrease between 1976 and 1999 (from 17.1 mu g/dL to 2.0 mu g/dL) was 2.2 times ($319 billion) that calculated using a linear-linear dose-response function ($149 billion). The Centers for Disease Control and Prevention action limit of 10 mu g/dL for children fails to protect against most damage and economic cost attributable to lead exposure.