Dockery D W
Environmental Epidemiology Program, Harvard School of Public Health, Boston, MA 02115.
Environ Health Perspect. 1993 Dec;101 Suppl 4(Suppl 4):187-91. doi: 10.1289/ehp.93101s4187.
Epidemiologic studies of the respiratory health effects of air pollution are intrinsically difficult because exposure is common, expected effects at concentrations found in developed countries are weak, random misclassification of exposure is common, and the respiratory health indicators have multiple etiologies. Exposures to air pollutants also are multidimensional, generally consisting of a mixture of gases and particles. In this paper, epidemiologic study designs are described, and their potential for evaluating effects of complex pollutant mixtures are discussed. Power to detect the independent effects of individual pollutants in a complex pollutant mixture or to measure their interactions is in general very weak unless the study is specifically designed to test such hypotheses. However, with innovative and creative design, the independent and joint effects of multiple pollutants should be estimable in epidemiologic studies.
空气污染对呼吸道健康影响的流行病学研究本质上具有难度，原因在于暴露普遍存在、在发达国家发现的浓度下预期的影响微弱、暴露的随机错误分类常见，且呼吸道健康指标有多种病因。空气污染物暴露也是多维度的，通常由气体和颗粒物的混合物组成。本文描述了流行病学研究设计，并讨论了其评估复杂污染物混合物影响的潜力。除非研究专门设计用于检验此类假设，否则在复杂污染物混合物中检测单个污染物的独立影响或测量其相互作用的能力一般非常弱。然而，通过创新和创造性的设计，多种污染物的独立和联合影响在流行病学研究中应是可估计的。
