Saracci R
Rev Epidemiol Sante Publique. 1979;27(5-6):409-23.
The geographical, or, more generally, the topographical approach to health and disease has common and important applications in occupational health studies. Analysis of disease occurrence (prevalence and incidence) by area may be carried out at three levels of observation: within the working environment, when different areas usually correspond to different exposures to potentially noxious agents; in the locality where the working environment is situated, which may be affected, for example, by routine industrial discharges or by pollution following accidents; and in the region which includes the locality. Epidemiological tools for the spatial investigation of disease occurrence at each of these levels are reviewed and exemplified, and possible sources of confounding and bias (positive and negative) are emphasized. Attention is particularly drawn to "false negative" results arising in occupational studies because of dilution of an excess risk limited to only some of the workers operating in a defined area.
地理，或者更宽泛地说，地形学方法在职业健康研究中对健康和疾病有着共同且重要的应用。按区域对疾病发生情况（患病率和发病率）进行分析可在三个观察层面展开：在工作环境内，此时不同区域通常对应着对潜在有害因素的不同暴露；在工作环境所在的当地，例如可能受到常规工业排放或事故后污染的影响；以及在包括该当地的区域内。本文对在这些层面上每个层面疾病发生情况空间调查的流行病学工具进行了综述并举例说明，同时强调了可能的混杂和偏倚（正向和负向）来源。尤其要注意职业研究中因仅在特定区域工作的部分工人存在的超额风险被稀释而产生的“假阴性”结果。
