Rybicki B A, Peterson E L, Johnson C C, Kortsha G X, Cleary W M, Gorell J M
Department of Biostatistics and Research Epidemiology, Henry Ford Health Sciences Center, Detroit, MI 48202-3450, USA.
Int J Epidemiol. 1998 Apr;27(2):269-73. doi: 10.1093/ije/27.2.269.
Among the methods of retrospective occupational exposure assessment, expert review is considered the most accurate. Although expert review provides a more objective measure of exposure, depending on the exposure of interest it may still result in a significant degree of misclassification.
To evaluate the reliability in occupational metal exposure assessment by expert review, we analysed job history data from a case-control study of a neurological disease. First, one industrial hygienist (IH) did an initial exposure assessment of the metals copper, iron and lead, blinded to case-control status, for 608 subjects who had 3033 total jobs. We then compared exposure assessments from the original review with a second blinded review of 60 job histories (306 jobs) by the same IH (intra-rater) and of 64 job histories (361 jobs) by a different IH (inter-rater).
The per cent agreements for the intra-IH comparisons were 89.6 for copper, 87.9 for iron and 94.6 for lead, whereas the inter-IH per cent agreements were 86.4 for copper, 81.1 for iron and 76.2 for lead. Based on the assumption that reliability is related to validity, we calculated an estimate of misclassification of metal exposure by one IH. Our exposure misclassification estimates show a sizable attenuation of the odds ratio, with the expected bias similar for copper and iron when using either intra- or inter-reliability results to estimate misclassification.
Our results suggest that variation in the expert assessment of metal exposure is due mainly to the difficulties involved in transforming an occupational history into an estimate of exposure.
在回顾性职业暴露评估方法中，专家评审被认为是最准确的。尽管专家评审能提供更客观的暴露测量，但根据所关注的暴露情况，它仍可能导致相当程度的错误分类。
为评估专家评审在职业金属暴露评估中的可靠性，我们分析了一项神经系统疾病病例对照研究的工作史数据。首先，一名工业卫生学家（IH）在不知道病例对照状态的情况下，对608名受试者的3033份工作进行了铜、铁和铅的初始暴露评估。然后，我们将原始评审的暴露评估与同一名工业卫生学家（评估者内）对60份工作史（306份工作）以及另一名不同的工业卫生学家（评估者间）对64份工作史（361份工作）进行的第二次盲法评审进行了比较。
工业卫生学家内部比较的百分比一致性，铜为89.6%，铁为87.9%，铅为94.6%；而工业卫生学家之间的百分比一致性，铜为86.4%，铁为81.1%，铅为76.2%。基于可靠性与有效性相关的假设，我们计算了一名工业卫生学家对金属暴露错误分类的估计值。我们的暴露错误分类估计显示优势比有相当程度的衰减，使用评估者内或评估者间的可靠性结果来估计错误分类时，铜和铁的预期偏差相似。
我们的结果表明，专家对金属暴露评估的差异主要是由于将职业史转化为暴露估计值存在困难。
