Correa Adolfo, Min Yuan-I, Stewart Patricia Ann, Lees Peter S J, Breysse Patrick, Dosemeci Mustafa, Jackson Leila W
Department of Epidemiology, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland, USA.
Birth Defects Res A Clin Mol Teratol. 2006 Nov;76(11):811-24. doi: 10.1002/bdra.20311.
Industrial hygienists' assessments of prenatal occupational exposures based on parental job histories is a promising approach for population-based case-control studies of birth defects and other perinatal outcomes. However, evaluations of inter-rater agreement of such assessments have been limited.
We examined inter-rater agreement of occupational lead exposure assessments of maternal job reports by industrial hygienists in a population-based case-control study of parental occupational lead exposure and low birth weight. A total of 178 jobs with potential exposure to lead during the 6 months before pregnancy to the end of pregnancy were examined. Three industrial hygienists evaluated these jobs independently for exposure to lead including probability of exposure, type of exposure, route of entry, exposure frequency, duration, and intensity. Inter-rater agreement of these assessments beyond chance was evaluated using the kappa statistic (kappa).
In general, inter-rater agreement was greater for assessment of direct exposures than assessment of indirect exposures. However, inter-rater agreement varied with the lead exposure metric under consideration, being: 1) fair to good for type of direct exposure (i.e., inorganic or organic), respiratory exposure and frequency of exposure to direct inorganic lead, hours per day of direct (i.e., inorganic or organic), and intensity of direct inorganic exposure; 2) poor for probability and type of indirect exposure (inorganic or organic); and 3) indeterminate for frequency of direct organic exposure, frequency of indirect exposures (organic or inorganic), and intensity of direct exposures (organic or inorganic).
Retrospective assessment of maternal prenatal exposures to lead by industrial hygienists can provide some reliable metrics of exposure for studies of perinatal outcomes. Reliability studies of such exposure assessments may be useful for: quantifying the reliability of derived exposure metrics; identifying exposure metrics for exposure-outcome analyses; and determining the reliability of prenatal occupational exposures to other agents of interest.
工业卫生学家基于父母工作经历对产前职业暴露进行评估，对于以人群为基础的出生缺陷及其他围产期结局病例对照研究而言是一种很有前景的方法。然而，对此类评估者间一致性的评价却很有限。
在一项关于父母职业性铅暴露与低出生体重的以人群为基础的病例对照研究中，我们检验了工业卫生学家对母亲工作汇报中职业性铅暴露评估的评估者间一致性。共检查了178个在怀孕前6个月至怀孕结束期间有铅暴露可能性的工作。三位工业卫生学家独立评估这些工作的铅暴露情况，包括暴露概率、暴露类型、进入途径、暴露频率、持续时间和强度。使用kappa统计量（kappa）评估这些评估超出偶然的评估者间一致性。
总体而言，直接暴露评估的评估者间一致性高于间接暴露评估。然而，评估者间一致性随所考虑的铅暴露指标而变化，具体如下：1）直接暴露类型（即无机或有机）、呼吸道暴露以及直接无机铅暴露频率、直接（即无机或有机）每天小时数和直接无机暴露强度的评估为一般到良好；2）间接暴露（无机或有机）的概率和类型评估较差；3）直接有机暴露频率、间接暴露（有机或无机）频率以及直接暴露（有机或无机）强度的评估不确定。
工业卫生学家对母亲产前铅暴露的回顾性评估可为围产期结局研究提供一些可靠的暴露指标。此类暴露评估的可靠性研究可能有助于：量化导出暴露指标的可靠性；确定用于暴露 - 结局分析的暴露指标；以及确定产前职业性暴露于其他相关因素的可靠性。
