Document Detail

Rethinking cumulative exposure in epidemiology, again.
MedLine Citation:
PMID:  25138292     Owner:  NLM     Status:  Publisher    
The use of cumulative exposure, the product of intensity and duration, has enjoyed great popularity in epidemiology of chronic diseases despite numerous known caveats in its interpretation. We briefly review the history of use of cumulative exposure in epidemiology and propose an alternative method for relating time-integrated exposures to health risks. We argue, as others before us have, that cumulative exposure metrics obscures the interplay of exposure intensity and duration. We propose to use a computationally simple alternative in which duration and intensity of exposure are modelled as a main effect and their interaction, cumulative exposure, only be added if there is evidence of deviation from this additive model. We also consider the Lubin-Caporaso model of interplay of exposure intensity and duration. The impact of measurement error in intensity on model selection was also examined. The value of this conceptualization is demonstrated using a simulation study and further illustrated in the context of respiratory health and occupational exposure to latex dust. We demonstrate why cumulative exposure has been so popular because the cumulative exposure metric per se gives a robust answer to the existence of an association, regardless of the underlying true mechanism of disease. Treating cumulative exposure as the interaction of main effects of exposure duration and intensity enables epidemiologists to derive more information about mechanism of disease then fitting cumulative exposure metric by itself, and without the need to collect additional data. We propose that the practice of fitting duration, intensity and cumulative exposure separately to epidemiologic data should lead to conceptualization of cumulative exposure as interaction of main effects of duration and intensity of exposure.Journal of Exposure Science and Environmental Epidemiology advance online publication, 20 August 2014; doi:10.1038/jes.2014.58.
Frank de Vocht; Igor Burstyn; Nuthchyawach Sanguanchaiyakrit
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-8-20
Journal Detail:
Title:  Journal of exposure science & environmental epidemiology     Volume:  -     ISSN:  1559-064X     ISO Abbreviation:  J Expo Sci Environ Epidemiol     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-8-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101262796     Medline TA:  J Expo Sci Environ Epidemiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
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