Department of Epidemiology, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
Occup Environ Med. 2012 Oct;69(10):745-51. doi: 10.1136/oemed-2011-100556. Epub 2012 Jun 12.
Reliable retrospective exposure assessment continues to be a challenge in most population-based studies. Several methodologies exist for estimating exposures retrospectively, of which case-by-case expert assessment and job-exposure matrices (JEMs) are commonly used. This study evaluated the reliability of exposure estimates for selected carcinogens obtained through three JEMs by comparing the estimates with case-by-case expert assessment within the Netherlands Cohort Study (NLCS).
The NLCS includes 58,279 men aged 55-69 years at enrolment in 1986. For a subcohort of these men (n=1630), expert assessment is available for exposure to asbestos, polycyclic aromatic hydrocarbons (PAHs) and welding fumes. Reliability of the different JEMs (DOMJEM (asbestos, PAHs), FINJEM (asbestos, PAHs and welding fumes) and Asbestos JEM (asbestos) was determined by assessing the agreement between these JEMs and the expert assessment.
Expert assessment revealed the lowest prevalence of exposure for all three exposures (asbestos 9.3%; PAHs 5.3%; welding fumes 11.7%). The DOMJEM showed the highest level of agreement with the expert assessment for asbestos and PAHs (κs=0.29 and 0.42, respectively), closely followed by the FINJEM. For welding fumes, concordance between the expert assessment and FINJEM was high (κ=0.70). The Asbestos JEM showed poor agreement with the expert asbestos assessment (κ=0.10).
This study shows case-by-case expert assessment to result in the lowest prevalence of occupational exposure in the NLCS. Furthermore, the DOMJEM and FINJEM proved to be rather similar in agreement when compared with the expert assessment. The Asbestos JEM appeared to be less appropriate for use in the NLCS.
可靠的回顾性暴露评估在大多数基于人群的研究中仍然是一个挑战。有几种方法可用于回顾性估计暴露，其中个案专家评估和职业暴露矩阵（JEM）是常用的方法。本研究通过比较荷兰队列研究（NLCS）中个案专家评估与三种 JEM 获得的选定致癌物暴露估计值，评估了这些 JEM 暴露估计值的可靠性。
NLCS 包括 1986 年招募时年龄在 55-69 岁的 58279 名男性。对于这些男性的一个子队列（n=1630），专家评估可用于接触石棉、多环芳烃（PAHs）和焊接烟尘。通过评估这些 JEM 与专家评估之间的一致性，确定了三种 JEM（DOMJEM（石棉、PAHs）、FINJEM（石棉、PAHs 和焊接烟尘）和 Asbestos JEM（石棉）的可靠性。
专家评估显示，所有三种暴露（石棉 9.3%；PAHs 5.3%；焊接烟尘 11.7%）的暴露率最低。DOMJEM 对石棉和 PAHs 的专家评估具有最高的一致性（κs=0.29 和 0.42），其次是 FINJEM。对于焊接烟尘，专家评估与 FINJEM 之间的一致性很高（κ=0.70）。Asbestos JEM 与专家石棉评估的一致性较差（κ=0.10）。
本研究表明，NLCS 中的个案专家评估导致职业暴露的最低患病率。此外，与专家评估相比，DOMJEM 和 FINJEM 的一致性相当。Asbestos JEM 似乎不太适合用于 NLCS。
