Comparison of two expert-based assessments of diesel exhaust exposure in a case-control study: programmable decision rules versus expert review of individual jobs

Occup Environ Med. 2012 Oct;69(10):752-8. doi: 10.1136/oemed-2011-100524. Epub 2012 Jul 27.

Abstract

Objectives: Professional judgment is necessary to assess occupational exposure in population-based case-control studies; however, the assessments lack transparency and are time-consuming to perform. To improve transparency and efficiency, we systematically applied decision rules to questionnaire responses to assess diesel exhaust exposure in the population-based case-control New England Bladder Cancer Study.

Methods: 2631 participants reported 14 983 jobs; 2749 jobs were administered questionnaires ('modules') with diesel-relevant questions. We applied decision rules to assign exposure metrics based either on the occupational history (OH) responses (OH estimates) or on the module responses (module estimates); we then combined the separate OH and module estimates (OH/module estimates). Each job was also reviewed individually to assign exposure (one-by-one review estimates). We evaluated the agreement between the OH, OH/module and one-by-one review estimates.

Results: The proportion of exposed jobs was 20-25% for all jobs, depending on approach, and 54-60% for jobs with diesel-relevant modules. The OH/module and one-by-one review estimates had moderately high agreement for all jobs (κ(w)=0.68-0.81) and for jobs with diesel-relevant modules (κ(w)=0.62-0.78) for the probability, intensity and frequency metrics. For exposed subjects, the Spearman correlation statistic was 0.72 between the cumulative OH/module and one-by-one review estimates.

Conclusions: The agreement seen here may represent an upper level of agreement because the algorithm and one-by-one review estimates were not fully independent. This study shows that applying decision-based rules can reproduce a one-by-one review, increase transparency and efficiency, and provide a mechanism to replicate exposure decisions in other studies.

Publication types

  • Comparative Study
  • Evaluation Study
  • Research Support, N.I.H., Intramural

MeSH terms

  • Air Pollutants, Occupational / analysis*
  • Air Pollutants, Occupational / toxicity
  • Algorithms
  • Case-Control Studies
  • Decision Support Techniques
  • Environmental Monitoring / methods*
  • Environmental Monitoring / statistics & numerical data
  • Expert Testimony
  • Humans
  • Models, Theoretical
  • Occupational Exposure / adverse effects
  • Occupational Exposure / analysis*
  • Occupational Exposure / statistics & numerical data
  • Retrospective Studies
  • Surveys and Questionnaires
  • Urinary Bladder Neoplasms / chemically induced
  • Vehicle Emissions / analysis*
  • Vehicle Emissions / toxicity

Substances

  • Air Pollutants, Occupational
  • Vehicle Emissions