Rappaport S M
Department of Environmental Sciences and Engineering, School of Public Health, University of North Carolina, Chapel Hill 27599.
Ann Occup Hyg. 1991 Feb;35(1):61-121. doi: 10.1093/annhyg/35.1.61.
Because airborne exposure varies greatly over time and between individual workers, occupational hygienists should adopt sampling strategies which recognize the inherent statistical nature of assessing exposure. This analysis indicates that the traditional practice of testing 'compliance' with occupational exposure limits (OELs) should be discarded. Rather, it is argued that acceptable exposure should be defined with reference to the exposure distribution. Regarding the many statistical issues which come into play, it is concluded that hygienists should continue to apply the log-normal model for summarizing and testing data. However, sampling designs should move away from methods which are biased (e.g. sampling only the worst case) and which rely upon job title and observation as the primary means of assigning workers into groups. Since exposure data often lack independence (e.g. owing to the autocorrelation of serial measurements) and there exist large differences in exposure between workers in the same job group, random sampling designs should be adopted. It is also shown that the relationship between the mean of a log-normal distribution and exposures in the right tail allows one to evaluate simultaneously the mean exposure and the maximum frequency with which exposures exceed the OEL. Investigation of the biological concepts relies heavily upon a conceptual model which depicts the exposure-response continuum as a sequence of time series related to exposure, burden, damage and risk. Analysis of the linkages between these processes identifies two kinetic conditions which are necessary if variability of exposure is to affect appreciably the individual's risk of chronic disease. First, the variation of exposure from interval to interval must be efficiently translated into burden and damage (no damping), and second, during periods of intense exposure the relationship between burden and damage must be non-linear (curving upwards). On the basis of current knowledge it appears that relatively few chronic toxicants satisfy both these conditions. Even for those substances which cause damage only when a threshold is exceeded, a statistical argument suggests that the maximum risk can still be related to the mean exposure received over time. It is concluded that the risk of chronic disease generally depends upon the mean exposure received by the individual worker over time. Thus, the sampling strategy must allow the distribution of individual mean exposures to be characterized across the population at risk. It follows from this paradigm for assessing exposures that relatively little effort should be devoted to the evaluation of short-term 'peak' exposures since such transients are unlikely to exert undue influence on long-term effects.(ABSTRACT TRUNCATED AT 400 WORDS)
由于空气中的暴露在不同时间以及个体工人之间差异极大,职业卫生学家应采用能认识到评估暴露所具有的内在统计学性质的采样策略。该分析表明,传统的检测是否“符合”职业接触限值(OELs)的做法应被摒弃。相反,有人认为应参照暴露分布来定义可接受暴露。鉴于诸多统计学问题都会起作用,得出的结论是卫生学家应继续应用对数正态模型来汇总和检验数据。然而,采样设计应摒弃有偏差的方法(例如仅对最糟情况进行采样)以及那些依赖职位名称和观察作为将工人分组的主要手段的方法。由于暴露数据往往缺乏独立性(例如由于连续测量的自相关性),并且同一工作组内工人之间的暴露存在很大差异,所以应采用随机采样设计。还表明对数正态分布的均值与右尾暴露之间的关系使人们能够同时评估平均暴露以及暴露超过职业接触限值的最大频率。对生物学概念的研究在很大程度上依赖于一个概念模型,该模型将暴露 - 反应连续体描述为与暴露、负荷、损害和风险相关的一系列时间序列。对这些过程之间联系的分析确定了两个动力学条件,要使暴露的变异性显著影响个体患慢性病的风险,这两个条件是必需的。首先,不同时间段之间暴露的变化必须有效地转化为负荷和损害(无衰减),其次,在高强度暴露期间,负荷与损害之间的关系必须是非线性的(向上弯曲)。基于目前的知识,似乎相对较少的慢性毒物能满足这两个条件。即使对于那些仅在超过阈值时才造成损害的物质,一个统计学观点表明最大风险仍然可能与个体随时间接受的平均暴露有关。得出的结论是,慢性病的风险通常取决于个体工人随时间接受的平均暴露。因此,采样策略必须能够刻画处于风险中的人群中个体平均暴露的分布情况。根据这种评估暴露的范式,应相对少地投入精力评估短期“峰值”暴露,因为此类瞬时暴露不太可能对长期影响产生不当影响。(摘要截选至400字)