Using Decision Rules to Assess Occupational Exposure in Population-Based Studies
- 7 Downloads
Purpose of Review
Population-based studies increasingly link task-based occupational questionnaire responses collected from subjects to exposure estimates via transparent, programmable decision rules. We reviewed recent applications and methodological developments of rule-based approaches.
Agent-specific decision rules require interviews incorporating work-task-based questions. Some studies have developed rules before the interviews took place, while others developed rules after the interviews were completed. Agreement between rule-based estimates and exposures assigned using job-by-job expert review were generally moderate to good (Kappa = 0.4–0.8). Rules providing quantitative intensity levels using measurement data or that integrate multiple independent exposure sources for the same job represent further advances to improve the characterization of occupational exposures in population studies.
Decision rules have provided transparent and reproducible assessments, reduce job-by-job review, and facilitate sensitivity analyses in epidemiologic studies. Future studies should consider the development of decision rules concurrent with the questionnaire design to facilitate occupational exposure assessment efforts.
KeywordsOccupational exposure assessment Decision rules Population-based studies
This work was supported by the Intramural Research Programs of the Division of Cancer Epidemiology and Genetics, National Cancer Institute.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.• Ge CB, Friesen MC, Kromhout H, Peters S, Rothman N, Lan Q, et al. Use and reliability of exposure assessment methods in occupational case-control studies in the general population: past, present, and future. Ann Work Expo Health. 2018;62(9):1047–63. https://doi.org/10.1093/annweh/wxy080 This paper provides a comprehensive review of retrospective exposure assessment methods used in population studies over the last 40 years. Google Scholar
- 4.Friesen M, Lavoué J, Teschke K, Van Tongeren M. Occupational exposure assessment in industry- and population-based epidemiological studies. In: Nieuwenhuijsen MJ, editor. Exposure Assessment in Environmental Epidemiology, 2nd edition. Oxford: Oxford University Press; 2015. p. 139–62.Google Scholar
- 5.Siemiatycki J. Exposure assessment in community-based studies of occupational cancer. Occup Hyg. 1996;3(1):41–58.Google Scholar
- 6.Kromhout H. Commentary. Occup Environ Med. 2002;59(9):594.Google Scholar
- 7.• Fritschi L, Friesen MC, Glass D, Benke G, Girschik J, Sadkowsky T. OccIDEAS: retrospective occupational exposure assessment in community-based studies made easier. J Environ Public Health. 2009;2009(957023):5. https://doi.org/10.1155/2009/957023 This study describes the theoretical framework and the development of decision rules and job-specific modules of the OccIDEAS approach. Google Scholar
- 8.•• Pronk A, Stewart PA, Coble JB, Katki HA, Wheeler DC, Colt JS, et al. Comparison of two expert-based assessments of diesel exhaust exposure in a case–control study: programmable decision rules versus expert review of individual jobs. Occup Environ Med. 2012;69(10):752–8. https://doi.org/10.1136/oemed-2011-100524 This study contains the earliest published rules used to assess retrospective occupational exposures for an existing study. It describes the development of exposure scenarios and decision rules to estimate exposure to diesel engine exhaust, and includes a comparison with job-by-job expert review. Google Scholar
- 9.• Friesen MC, Wheeler DC, Vermeulen R, Locke SJ, Zaebst DD, Koutros S, et al. Combining decision rules from classification tree models and expert assessment to estimate occupational exposure to diesel exhaust for a case-control study. Ann Occup Hyg. 2016;60(4):467–78. https://doi.org/10.1093/annhyg/mev095 This study describes the transposition of decision rules between countries (United States and Spain) and the use of reliability assessment to prioritize jobs requiring additional expert review. Google Scholar
- 10.Fidler AT, Baker EL, Letz RE. Estimation of long term exposure to mixed solvents from questionnaire data: a tool for epidemiological investigations. Br J Ind Med. 1987;44(2):133–41.Google Scholar
- 19.• Peters S, Glass DC, Milne E, Fritschi L. Aus-ALL consortium. Rule-based exposure assessment versus case-by-case expert assessment using the same information in a community-based study. Occup Environ Med. 2014;71(3):215–9. https://doi.org/10.1136/oemed-2013-101699 This study compares exposures assigned using decision rule to those from job-by-job review for solvents, pesticides, and diesel exhaust. It found higher agreement for lifetime cumulative exposure than for individual jobs and for jobs with interview data. Google Scholar
- 20.Dopart PJ, Locke SJ, Cocco P, Bassig BA, Josse PR, Stewart PA et al. Estimation of source-specific occupational benzene exposure in a population-based case control study of non-Hodgkin lymphoma. Ann Work Exp Health. In press.Google Scholar
- 21.Friesen MC, Pronk A, Wheeler DC, Chen Y-C, Locke SJ, Zaebst DD, et al. Comparison of algorithm-based estimates of occupational diesel exhaust exposure to those of multiple independent raters in a population-based case–control study. Ann Occup Hyg. 2013;57(4):470–81. https://doi.org/10.1093/annhyg/mes082.Google Scholar
- 22.• Wheeler DC, Burstyn I, Vermeulen R, Yu K, Shortreed SM, Pronk A, et al. Inside the black box: starting to uncover the underlying decision rules used in a one-by-one expert assessment of occupational exposure in case-control studies. Occup Environ Med. 2013;70(3):203–10. https://doi.org/10.1136/oemed-2012-100918 This study describes the application of classification and regression tree models to job-by-job expert assessment data to reconstruct the internal decision rules of experts. Google Scholar
- 24.•• Callahan CL, Locke SJ, Dopart PJ, Stewart PA, Schwartz K, Ruterbusch JJ, et al. Decision rule approach applied to estimate occupational lead exposure in a case-control study of kidney cancer. Am J Ind Med. 2018;61(11):901–10. https://doi.org/10.1002/ajim.22912 This is the first population-based study to describe the development of source-specific decision rules to assign retrospective occupational exposures. Google Scholar
- 26.Friesen MC, Park D-U, Colt JS, Baris D, Schwenn M, Karagas MR, et al. Developing estimates of frequency and intensity of exposure to three types of metalworking fluids in a population-based case–control study of bladder cancer. Am J Ind Med. 2014;57(8):915–27. https://doi.org/10.1002/ajim.22328.Google Scholar
- 27.• Bourgkard E, Wild P, Gonzalez M, Févotte J, Penven E, Paris C. Comparison of exposure assessment methods in a lung cancer case-control study: performance of a lifelong task-based questionnaire for asbestos and PAHs. Occup Environ Med. 2013;70(12):884–91. https://doi.org/10.1136/oemed-2013-101467 This is the only population-based study comparing the exposures assigned using several assessment approaches that included task-based decision rules. Google Scholar
- 28.Wild P, Schill W, Bourgkard E, Drescher K, Gonzalez M, Paris C. The 2-phase case–control design: an efficient way to use expert-time. Scand J Work Environ Health. 2016;42(2):162–9. https://doi.org/10.5271/sjweh.3547.
- 29.• Dopart PJ, Friesen MC. New opportunities in exposure assessment of occupational epidemiology: use of measurements to aid exposure reconstruction in population-based studies. Curr Environ Health Rep. 2017;4(3):355–63. https://doi.org/10.1007/s40572-017-0153-0 This paper reviews sources of workplace measurement data and their applications in exposure assessment for population-based studies, including for the development of decision rules. Google Scholar
- 31.Locke SJ, Deziel NC, Koh D-H, Graubard BI, Purdue MP, Friesen MC. Evaluating predictors of lead exposure for activities disturbing materials painted with or containing lead using historic published data from U.S. workplaces. Am J Ind Med. 2017;60(2):189–97. https://doi.org/10.1002/ajim.22679.Google Scholar
- 32.Friesen MC, Locke SJ, Tornow C, Chen Y-C, Koh D-H, Stewart PA, et al. Systematically extracting metal- and solvent-related occupational information from free-text responses to lifetime occupational history questionnaires. Ann Occup Hyg. 2014;58(5):612–24. https://doi.org/10.1093/annhyg/meu012.Google Scholar
- 33.Friesen MC, Shortreed SM, Wheeler DC, Burstyn I, Vermeulen R, Pronk A, et al. Using hierarchical cluster models to systematically identify groups of jobs with similar occupational questionnaire response patterns to assist rule-based expert exposure assessment in population-based studies. Ann Occup Hyg. 2015;59(4):455–66. https://doi.org/10.1093/annhyg/meu101.Google Scholar
- 34.Siemiatycki J. Risk factors for cancer in the workplace. Boca Raton: CRC Press; 1991.Google Scholar
- 49.•• Lewkowski K, McCausland K, Heyworth JS, Li IW, Williams W, Fritschi L. Questionnaire-based algorithm for assessing occupational noise exposure of construction workers. Occup Environ Med. 2018;75(3):237–42. https://doi.org/10.1136/oemed-2017-104381 This study represents the first validation of exposures assigned by decision rules. Using a subset of recent construction jobs for which noise dosimetry measurements were collected, the sensitivity and specificity of OccIDEAS to identify jobs exposed above the Australian noise exposure limit was 83% and 69%, respectively. Google Scholar
- 50.• Florath I, Glass DC, Rhazi MS, Parent ME, Fritschi L. Inter-rater agreement between exposure assessment using automatic algorithms and using experts. Ann Work Exp Health. 2018;63(1):45–53. https://doi.org/10.1093/annweh/wxy084 This study compared exposures assigned using decision rules to those assigned by two experts, with one expert involved in developing the rules, and the other expert being independent. It also showed higher agreement using the consensus rating of the two experts. Google Scholar
- 52.Susi P, Goldberg M, Barnes P, Stafford E. The use of a task-based exposure assessment model (T-BEAM) for assessment of metal fume exposures during welding and thermal cutting. Appl Occup Environ Hyg. 2000;15(1):26–38.Google Scholar
- 61.Vila J, Turner MC, Gracia-Lavedan E, Figuerola J, Bowman JD, Kincl L, et al. Occupational exposure to high-frequency electromagnetic fields and brain tumor risk in the INTEROCC study: an individualized assessment approach. Environ Int. 2018;119:353–65. https://doi.org/10.1016/j.envint.2018.06.038.Google Scholar
- 62.Gérin M, Fletcher AC, Gray C, Winkelmann R, Boffetta P, Simonato L. Development and use of a welding process exposure matrix in a historical prospective study of lung cancer risk in European welders. Int J Epidemiol. 1993;22(Suppl 2):S22–8.Google Scholar
- 71.Chen YC, Coble JB, Deziel NC, Ji BT, Xue S, Lu W, et al. Reliability and validity of expert assessment based on airborne and urinary measures of nickel and chromium exposure in the electroplating industry. J Expo Sci Environ Epidemiol. 2014;24(6):622–8. https://doi.org/10.1038/jes.2014.22.Google Scholar
- 73.Sauvé J, Ramsay J, Locke S, Dopart P, Josse P, Zaebst D et al. Validity of retrospective occupational exposure estimates of lead and manganese in a case-control study. Occup Environ Med. https://doi.org/10.1136/oemed-2019-105744.