Risk of Bias Assessments and Evidence Syntheses for Observational Epidemiologic Studies of Environmental and Occupational Exposures: Strengths and Limitations.

Autor: Steenland K; Rollins School of Public Health, Emory University, Atlanta, Georgia, USA., Schubauer-Berigan MK; International Agency for Research on Cancer (IARC), Lyon, France., Vermeulen R; Institute for Risk Assessment Science, University of Utrecht, Utrecht, Netherlands., Lunn RM; Division of the National Toxicology Program (NTP), NIEHS, Research Triangle Park, North Carolina, USA., Straif K; Global Observatory on Pollution and Health, Boston College, Boston, Massachusetts, USA.; ISGlobal, Barcelona, Spain., Zahm S; Shelia Zahm Consulting, Hermon, Maine, USA., Stewart P; Stewart Exposure Assessments, LLC, Arlington, Virginia, USA., Arroyave WD; Integrated Laboratory Systems, Morrisville, North Carolina, USA., Mehta SS; Division of the National Toxicology Program (NTP), NIEHS, Research Triangle Park, North Carolina, USA., Pearce N; London School of Hygiene and Tropical Medicine, London, UK.
Jazyk: angličtina
Zdroj: Environmental health perspectives [Environ Health Perspect] 2020 Sep; Vol. 128 (9), pp. 95002. Date of Electronic Publication: 2020 Sep 14.
DOI: 10.1289/EHP6980
Abstrakt: Background: Increasingly, risk of bias tools are used to evaluate epidemiologic studies as part of evidence synthesis (evidence integration), often involving meta-analyses. Some of these tools consider hypothetical randomized controlled trials (RCTs) as gold standards.
Methods: We review the strengths and limitations of risk of bias assessments, in particular, for reviews of observational studies of environmental exposures, and we also comment more generally on methods of evidence synthesis.
Results: Although RCTs may provide a useful starting point to think about bias, they do not provide a gold standard for environmental studies. Observational studies should not be considered inherently biased vs. a hypothetical RCT. Rather than a checklist approach when evaluating individual studies using risk of bias tools, we call for identifying and quantifying possible biases, their direction, and their impacts on parameter estimates. As is recognized in many guidelines, evidence synthesis requires a broader approach than simply evaluating risk of bias in individual studies followed by synthesis of studies judged unbiased, or with studies given more weight if judged less biased. It should include the use of classical considerations for judging causality in human studies, as well as triangulation and integration of animal and mechanistic data.
Conclusions: Bias assessments are important in evidence synthesis, but we argue they can and should be improved to address the concerns we raise here. Simplistic, mechanical approaches to risk of bias assessments, which may particularly occur when these tools are used by nonexperts, can result in erroneous conclusions and sometimes may be used to dismiss important evidence. Evidence synthesis requires a broad approach that goes beyond assessing bias in individual human studies and then including a narrow range of human studies judged to be unbiased in evidence synthesis. https://doi.org/10.1289/EHP6980.
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje