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Incorporating individual-level distributions of exposure error in epidemiologic analyses: an example using arsenic in drinking water and bladder cancer.

ABSTRACT: Epidemiologic analyses traditionally rely on point estimates of exposure for assessing risk despite exposure error. We present a strategy that produces a range of risk estimates reflecting distributions of individual-level exposure.Quantitative estimates of exposure and its associated error are used to create for each individual a normal distribution of exposure estimates which is then sampled using Monte Carlo simulation. After the exposure estimate is sampled, the relationship between exposure and disease is evaluated; this process is repeated 99 times generating a distribution of risk estimates and confidence intervals. This is demonstrated in a bladder cancer case-control study using individual-level distributions of exposure to arsenic in drinking water.Sensitivity analyses indicate similar performance for categorical or continuous exposure estimates, and that increases in exposure error translate into a wider range of risk estimates. Bladder cancer analyses yield a wide range of possible risk estimates, allowing quantification of exposure error in the association between arsenic and bladder cancer, typically ignored in conventional analyses.Incorporating distributions of individual-level exposure error results in a more nuanced depiction of epidemiologic findings. This approach can be readily adopted by epidemiologists assuming distributions of individual-level exposure.

SUBMITTER: Meliker JR

PROVIDER: S-EPMC2947941 | biostudies-literature | 2010 Oct

REPOSITORIES: biostudies-literature

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Incorporating individual-level distributions of exposure error in epidemiologic analyses: an example using arsenic in drinking water and bladder cancer.

Meliker Jaymie R JR Goovaerts Pierre P Jacquez Geoffrey M GM Nriagu Jerome O JO

Annals of epidemiology 20101001 10

<h4>Purpose</h4>Epidemiologic analyses traditionally rely on point estimates of exposure for assessing risk despite exposure error. We present a strategy that produces a range of risk estimates reflecting distributions of individual-level exposure.<h4>Methods</h4>Quantitative estimates of exposure and its associated error are used to create for each individual a normal distribution of exposure estimates which is then sampled using Monte Carlo simulation. After the exposure estimate is sampled, t ...[more]

PMID: 20816314

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Project description:Bladder cancer mortality rates have been elevated in northern New England for at least five decades. Incidence rates in Maine, New Hampshire, and Vermont are about 20% higher than the United States overall. We explored reasons for this excess, focusing on arsenic in drinking water from private wells, which are particularly prevalent in the region.In a population-based case-control study in these three states, 1213 bladder cancer case patients and 1418 control subjects provided information on suspected risk factors. Log transformed arsenic concentrations were estimated by linear regression based on measurements in water samples from current and past homes. All statistical tests were two-sided.Bladder cancer risk increased with increasing water intake (Ptrend = .003). This trend was statistically significant among participants with a history of private well use (Ptrend = .01). Among private well users, this trend was apparent if well water was derived exclusively from shallow dug wells (which are vulnerable to contamination from manmade sources, Ptrend = .002) but not if well water was supplied only by deeper drilled wells (Ptrend = .48). If dug wells were used pre-1960, when arsenical pesticides were widely used in the region, heavier water consumers (>2.2?L/day) had double the risk of light users (<1.1?L/day, Ptrend = .01). Among all participants, cumulative arsenic exposure from all water sources, lagged 40 years, yielded a positive risk gradient (Ptrend = .004); among the highest-exposed participants (97.5th percentile), risk was twice that of the lowest-exposure quartile (odds ratio = 2.24, 95% confidence interval = 1.29 to 3.89).Our findings support an association between low-to-moderate levels of arsenic in drinking water and bladder cancer risk in New England. In addition, historical consumption of water from private wells, particularly dug wells in an era when arsenical pesticides were widely used, was associated with increased bladder cancer risk and may have contributed to the New England excess.

Dataset Information

Incorporating individual-level distributions of exposure error in epidemiologic analyses: an example using arsenic in drinking water and bladder cancer.

Publications

Incorporating individual-level distributions of exposure error in epidemiologic analyses: an example using arsenic in drinking water and bladder cancer.

Similar Datasets

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