Orlowski E, Pohlabeln H, Berrino F, Ahrens W, Bolm-Audorff U, Grossgarten K, Iwatsubo Y, Jöckel K H, Brochard P
INSERM U.139, CHU Henri Mondor, Créteil, France.
Int J Epidemiol. 1993;22 Suppl 2:S96-105. doi: 10.1093/ije/22.supplement_2.s96.
Retrospective assessment of asbestos exposure--II. At the job level: Complementarity of job-specific questionnaire and job exposure matrices. International Journal of Epidemiology 1993; 22 (Suppl. 2): S96-S105. The assessments of asbestos exposure by two a priori job exposure matrices (JEM) and by a job-specific questionnaire (SQ) are compared at job level. The data used for the comparison were generated by an ongoing case-control study on lung cancer in a region of northern Germany with a relatively high past prevalence of asbestos exposure. Among job periods assessed as unexposed by either JEM, 96% are recognized as such by the SQ. Discrepancies between the SQ and JEM were observed in jobs rated potentially exposed by the JEM. Despite varying estimates, the JEM and SQ were consistent as regards the relative classification of job periods by probability of exposure. The concordance of the methods, estimated by Kappa statistics, was stronger for the two JEM than for either of the JEM and the SQ. The identification of specific occupation/industry combinations in which discrepancies were most frequent and the comparison with expert ratings in some jobs yield insights into the sources of the disagreement between the methods. The misclassification of exposure by the JEM usually results in an overestimation of exposure. This is essentially related to loss of information due to the use of job codes as surrogates for job task descriptions and to the insufficiency of published data on asbestos exposure in different industries. As regards the SQ, two main sources of potential loss of sensitivity were identified: 1) possible omission of indirect sources of exposure by this method, 2) possible incompleteness of the SQ. The present comparison of methods of asbestos exposure assessment does not allow any one approach to be considered superior to another. Indeed, as proposed by Ahrens et al. in Part I of the study, both should be used to ensure optimal epidemiological performance.
石棉暴露的回顾性评估——II. 在工作层面：特定工作问卷与工作暴露矩阵的互补性。《国际流行病学杂志》1993年；22（增刊2）：S96 - S105。在工作层面比较了两种先验工作暴露矩阵（JEM）和特定工作问卷（SQ）对石棉暴露的评估。用于比较的数据来自德国北部一个过去石棉暴露患病率相对较高地区正在进行的一项肺癌病例对照研究。在被JEM评估为未暴露的工作时段中，96%被SQ认定为未暴露。在被JEM评定为潜在暴露的工作中观察到了SQ与JEM之间的差异。尽管估计值有所不同，但JEM和SQ在按暴露概率对工作时段进行相对分类方面是一致的。通过卡方统计估计，两种JEM方法之间的一致性比JEM与SQ中的任何一种与另一种之间的一致性更强。识别出差异最频繁出现的特定职业/行业组合，并与某些工作中的专家评级进行比较，有助于深入了解两种方法之间分歧的来源。JEM对暴露的错误分类通常导致暴露的高估。这主要与使用工作代码作为工作任务描述的替代物导致的信息丢失以及不同行业已发表的石棉暴露数据不足有关。关于SQ，确定了两个可能导致敏感性丧失的主要来源：1）这种方法可能遗漏间接暴露源，2）SQ可能不完整。目前对石棉暴露评估方法的比较并不允许认为任何一种方法优于另一种。实际上，正如阿伦斯等人在该研究的第一部分所提议的，两种方法都应使用以确保最佳的流行病学表现。
