Comparison of asbestos exposure assessments by next-of-kin respondents, by an occupational hygienist, and by a job-exposure matrix from the National Occupational Hazard Survey.
BACKGROUND
Assessments of occupational exposures in case-control studies of rapidly fatal illnesses often rely on data from next-of-kin respondents, which may be inaccurate.


METHODS
Three methods for assessing exposure to asbestos from case-control data on mesothelioma, including next-of-kin assessment, expert assessment, and use of a generic job-exposure matrix (JEM). Interview data [Spirtas et al. (1994): Occup Environ Med 51:804-811] were reviewed to determine exposure status by an occupational hygienist (C.R.) who was unaware of disease status. Exposure odds ratios were calculated using standard methods, and measures of agreement included the kappa statistic and conditional and marginal odds ratios.


RESULTS
Expert assessment detected higher proportions of exposed subjects than the next-of-kin respondents or JEM methods. The disease-exposure odds ratios were highest for respondents, perhaps because of recall bias, and lowest for the JEM method. The agreement was highest between the respondent and expert assessments. A combination of respondent's assessment and JEM assessment led to the best prediction of the expert's assessment. Results for spouse respondents were similar to those for other "next-of-kin" respondents.


CONCLUSIONS
Expert assessments were the most plausible, but the data indicate that disease associations could also be detected with the other exposure assessment methods. Using some combination of the proxy respondent's assessment and the JEM assessment, one can predict the expert's assessment. A strategy that relied on the respondent's assessment when it was positive and otherwise obtained an expert assessment could reduce costs with little error, compared to expert assessment on all subjects.
Nam
Jun-mo
JM
Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health & Human Services, Bethesda, Maryland, USA. namj@mail.nih.gov
Rice
Carol
C
Gail
Mitchell H
MH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001194:Asbestos / Q000633:toxicity*; D015982:Bias; D016022:Case-Control Studies; D003644:Death Certificates; D005190:Family; D006306:Health Surveys; D006801:Humans; D015141:Los Angeles / Q000453:epidemiology; D011939:Mental Recall; D008654:Mesothelioma / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis / Q000706:statistics & numerical data*; D009787:Occupational Medicine; D019727:Proxy; D012042:Registries; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods
D001194:Asbestos