Schlaefer Klaus, Schlehofer Brigitte, Schüz Joachim
Unit of Environmental Epidemiology, German Cancer Research Centre, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
Eur J Epidemiol. 2009;24(8):469-75. doi: 10.1007/s10654-009-9357-4. Epub 2009 Jun 19.
In all epidemiological studies the validity of self-reported questionnaire data is an important issue as the exposure assessment based on such data is a major source of bias in the risk estimation. A validation study was conducted based on a case-control study including 94 acoustic neuroma cases and 191 matched controls from the German Interphone Study to investigate the level of agreement between self-reported occupational noise exposure and a job-exposure-matrix (JEM) on noise exposure derived from a lifetime occupation calendar. The JEM was generated based on measurement data collected in the literature for various occupations. Level of agreement was investigated by using sensitivity, specificity, kappa coefficient and the Youden-Index. The receiver operating characteristics curve yielded an optimal cut point of 80 decibel(Acoustic) (dB(A)) to dichotomize noise exposure, displaying a moderate agreement between self-reported exposure and the JEM-based exposure (kappa of 0.53) that was slightly higher for cases than controls (kappas of 0.62 and 0.48). The agreement was only slightly lower if the longest held job or the last held job were used instead of the loudest job of the lifetime job history. The cut point of 80 dB(A) corresponds with regulations for workers safety with a recommendation to wear noise protection. The good levels of agreement between self-reported high occupational noise exposure compared with JEM-data, together with no substantial differences between cases and controls, suggest that self-reported data on occupational noise exposure is a valid exposure metric. Noise exposure appears to be appropriate if only exposure information on the last or the longest held job is available.
在所有流行病学研究中,自我报告的问卷调查数据的有效性都是一个重要问题,因为基于此类数据的暴露评估是风险估计中偏差的主要来源。基于一项病例对照研究进行了一项验证研究,该研究包括来自德国对讲机研究的94例听神经瘤病例和191例匹配对照,以调查自我报告的职业噪声暴露与从终身职业日历得出的噪声暴露工作暴露矩阵(JEM)之间的一致性水平。JEM是根据文献中收集的各种职业的测量数据生成的。通过使用敏感性、特异性、kappa系数和尤登指数来研究一致性水平。受试者工作特征曲线得出将噪声暴露二分的最佳切点为80分贝(声学)(dB(A)),显示自我报告的暴露与基于JEM的暴露之间存在中等一致性(kappa为0.53),病例的一致性略高于对照(kappa分别为0.62和0.48)。如果使用任职时间最长的工作或最后一份工作代替终身工作经历中噪声最大的工作,一致性仅略低。80 dB(A)的切点符合工人安全规定,并建议佩戴噪声防护装备。与JEM数据相比,自我报告的高职业噪声暴露之间的良好一致性水平,以及病例与对照之间没有实质性差异,表明自我报告的职业噪声暴露数据是一个有效的暴露指标。如果仅可获得关于最后一份或任职时间最长的工作的暴露信息,噪声暴露似乎是合适的。