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Systematic review
Systematic review of methods used to assess exposure to pesticides in occupational epidemiology studies, 1993–2017
  1. Johan Ohlander1,
  2. Samuel Fuhrimann1,
  3. Ioannis Basinas2,
  4. John W Cherrie2,3,
  5. Karen S Galea2,
  6. Andrew C Povey4,
  7. Martie van Tongeren4,
  8. Anne-Helen Harding5,
  9. Kate Jones5,
  10. Roel Vermeulen1,
  11. Hans Kromhout1
  1. 1 Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
  2. 2 Institute of Occupational Medicine (IOM), Edinburgh, United Kingdom
  3. 3 Institute of Biological Chemistry, Biophysics and Bioengineering, Heriot Watt University, Edinburgh, UK
  4. 4 Centre for Occupational and Environmental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
  5. 5 Health and Safety Executive, Harpur Hill, Buxton, UK
  1. Correspondence to Professor Hans Kromhout, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, Netherlands; h.kromhout{at}uu.nl

Abstract

Objective Numerous 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.

Methods We 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.

Results In 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.

Conclusion Over 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.

  • pesticides
  • exposure assessment
  • epidemiology
  • systematic review
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/oemed-2019-105880

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    • Contributors The undersigned author warrants that the article is original, is not under consideration by another journal and has not been published previously. The authors have read and approved this manuscript for publication. All authors meet the criteria for authorship stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals. JO had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. JO was involved in the conception and design, acquisition of data, analysis and interpretation of the data and drafting of the manuscript. HK was involved in the conception and design, analysis and interpretation of the data and review of the manuscript. All other authors (SF, IB, JWC, KG, AP, MvT, AHH, KJ, RV) were involved in the interpretation of the data and review of the manuscript. SF additionally created the figure depicting the study locations of the analysed articles.

    • Funding This study was supported by the European Crop Protection Association (ECPA). The sponsor had no role in the design and conduct of the study, collection, management, analysis and interpretation of the data, nor in preparation, review or approval of the manuscript.

    • Map disclaimer The depiction of boundaries on the map(s) in this article do not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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