Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3508TD Utrecht, The Netherlands; Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorstraat 7, 1081BT Amsterdam, The Netherlands.
Institute for Risk Assessment Sciences (IRAS), Division of Environmental Epidemiology, Utrecht University, Yalelaan 2, 3508TD Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Universiteitsweg 100, 3584CG Utrecht, The Netherlands.
Sci Total Environ. 2018 Oct 15;639:75-83. doi: 10.1016/j.scitotenv.2018.05.007. Epub 2018 May 17.
Psychosocial research has shown that perceived exposure can influence symptom reporting, regardless of actual exposure. The impact of this phenomenon on the interpretation of results from epidemiological research on environmental determinants of symptoms is unclear.
Our aim was to compare associations between modeled exposures, the perceived level of these exposures and reported symptoms (non-specific symptoms, sleep disturbances, and respiratory symptoms) for three different environmental exposures (radiofrequency electromagnetic fields (RF-EMF), noise, and air pollution). These environmental exposures vary in the degree to which they can be sensorially observed.
Participant characteristics, perceived exposures, and self-reported health were assessed with a baseline (n = 14,829, 2011/2012) and follow-up (n = 7905, 2015) questionnaire in the Dutch population-based Occupational and Environmental Health Cohort (AMIGO). Environmental exposures were estimated at the home address using spatial models. Cross-sectional and longitudinal regression models were used to examine the associations between modeled and perceived exposures, and reported symptoms.
The extent to which exposure sources could be observed by participants likely influenced correlations between modeled and perceived exposure as correlations were moderate for air pollution (r = 0.34) and noise (r = 0.40), but less so for RF-EMF (r = 0.11). Perceived exposures were consistently associated with increased symptom scores (respiratory, sleep, non-specific). Modeled exposures, except RF-EMF, were associated with increased symptom scores, but these associations disappeared or strongly diminished when accounted for perceived exposure in the analyses.
Perceived exposure has an important role in symptom reporting. When environmental determinants of symptoms are studied without acknowledging the potential role of both modeled and perceived exposures, there is a risk of bias in health risk assessment. However, the etiological role of exposure perceptions in relation to symptom reporting requires further research.
社会心理研究表明，无论实际暴露如何，感知暴露都会影响症状报告。这种现象对解释环境因素与症状之间关系的流行病学研究结果的影响尚不清楚。
我们旨在比较三种不同环境暴露（射频电磁场（RF-EMF）、噪声和空气污染）的建模暴露、感知暴露水平与报告症状（非特异性症状、睡眠障碍和呼吸道症状）之间的关联。这些环境暴露在可感知程度上存在差异。
在荷兰基于人群的职业和环境健康队列（AMIGO）中，使用基线（n=14829，2011/2012 年）和随访（n=7905，2015 年）问卷调查参与者特征、感知暴露和自我报告的健康状况。使用空间模型在家庭住址处估计环境暴露。使用横断面和纵向回归模型检验模型化和感知暴露与报告症状之间的关联。
参与者观察到的暴露源的程度可能影响模型化和感知暴露之间的相关性，因为空气污染（r=0.34）和噪声（r=0.40）的相关性适中，但射频电磁场（r=0.11）的相关性较低。感知暴露与症状评分增加（呼吸道、睡眠、非特异性）一致相关。除射频电磁场外，模型化暴露与症状评分增加相关，但在分析中考虑到感知暴露后，这些关联消失或大大减弱。
感知暴露在症状报告中起着重要作用。当研究症状的环境决定因素而不承认模型化和感知暴露的潜在作用时，健康风险评估可能存在偏倚。然而，暴露感知在症状报告中的病因作用需要进一步研究。
