Hertzman C, Hayes M, Singer J, Highland J
Department of Health Care and Epidemiology, University of British Columbia, Vancouver, Canada.
Environ Health Perspect. 1987 Nov;75:173-95. doi: 10.1289/ehp.8775173.
This report describes the design and conduct of two sequential historical prospective morbidity surveys of workers and residents from the Upper Ottawa Street Landfill Site in Hamilton, Ontario. The workers study was carried out first and was a hypothesis-generating study. Workers and controls were administered a health questionnaire, which was followed by an assessment of recall bias through medical chart abstraction. Multiple criteria were used to identify health problems associated with landfill site exposure. Those problems with highest credibility included clusters of respiratory, skin, narcotic, and mood disorders. These formed the hypothesis base in the subsequent health study of residents living adjacent to the landfill site. In that study, the association between mood, narcotic, skin, and respiratory conditions with landfill site exposure was confirmed using the following criteria: strength of association; consistency with the workers study; risk gradient by duration of residence and proximity to the landfill; absence of evidence that less healthy people moved to the area; specificity; and the absence of recall bias. The validity of these associations were reduced by three principal problems: the high refusal rate among the control population; socioeconomic status differences between the study groups; and the fact that the conditions found in excess were imprecisely defined and potentially interchangeable with other conditions. Offsetting these problems were the multiple criteria used to assess each hypothesis, which were applied according to present rules. Evidence is presented that supports the hypothesis that vapors, fumes, or particulate matter emanating from the landfill site, as well as direct skin exposure, may have lead to the health problems found in excess. Evidence is also presented supporting the hypothesis that perception of exposure and, therefore, of risk, may explain the results of the study. However, based on the analyses performed, it is the conclusion of the authors that the adverse effects seen were more likely the result of chemical exposure than of perception of risk.
本报告描述了对安大略省汉密尔顿上渥太华街垃圾填埋场的工人和居民进行的两项连续的历史性前瞻性发病率调查的设计与实施情况。首先开展的是工人研究，这是一项产生假设的研究。对工人和对照组进行了健康问卷调查，随后通过病历摘要评估回忆偏倚。使用多个标准来识别与垃圾填埋场接触相关的健康问题。可信度最高的问题包括呼吸系统、皮肤、麻醉品和情绪障碍集群。这些问题构成了后续对垃圾填埋场附近居民进行健康研究的假设基础。在该研究中，使用以下标准确认了情绪、麻醉品、皮肤和呼吸系统疾病与垃圾填埋场接触之间的关联：关联强度；与工人研究的一致性；根据居住时间和与垃圾填埋场的距离得出的风险梯度；没有证据表明健康状况较差的人迁入该地区；特异性；以及没有回忆偏倚。这些关联的有效性因三个主要问题而降低：对照组人群的高拒绝率；研究组之间的社会经济地位差异；以及发现的疾病定义不精确且可能与其他疾病相互混淆这一事实。抵消这些问题的是根据现行规则用于评估每个假设的多个标准。有证据支持这样的假设，即垃圾填埋场散发的蒸气、烟雾或颗粒物以及直接的皮肤接触可能导致了发现的过多健康问题。也有证据支持这样的假设，即对接触以及因此对风险的认知可能解释了研究结果。然而，根据所进行的分析，作者的结论是，所观察到的不利影响更可能是化学接触的结果，而非风险认知的结果。
