Spatial Analysis of the Air Pollution--Mortality Relationship in the Context of Ecologic Confounders
| Autor: | Norm Finkelstein, Mark S. Goldberg, Richard T. Burnett, Michael Jerrett, Alette Willis, Patrick F. DeLuca, Daniel Krewski |
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| Rok vydání: | 2003 |
| Předmět: |
Lung Diseases
Lung Neoplasms Databases Factual Heart Diseases Health Toxicology and Mutagenesis Context (language use) Toxicology Air Pollution Covariate Econometrics Humans Social determinants of health Mortality Proportional Hazards Models Models Statistical Ecology Proportional hazards model Multilevel model Confounding Regression analysis Epidemiologic Studies Geography Socioeconomic Factors Health Income Risk assessment Algorithms |
| Zdroj: | Journal of Toxicology and Environmental Health, Part A. 66:1735-1778 |
| ISSN: | 1087-2620 1528-7394 |
| DOI: | 10.1080/15287390306438 |
| Popis: | Lack of control for confounding by ecological covariates that may relate to sulfate air pollution and mortality was a key criticism of the two studies that were the focus of the Particle Reanalysis Project. To assess the validity of this criticism, we address the question: "Does sulfate air pollution exert health effects when the impact of other individual and ecologic variables thought to influence health is taken into account?" A related question arises from the possibility of autocorrelation in the mortality risks and ecologic covariates. Failure to control for autocorrelation can lead to false positive significance tests and may indicate bias resulting from a missing variable or group of variables. We control for more than 25 individual risk factors and for 20 ecologic variables representing environmental, socioeconomic, demographic, health- care, and lifestyle determinants of health in a two-stage multilevel analysis. Four modeling strategies are used to control for spatial autocorrelation. Of the 20 ecologic variables tested, only sulfate and sulfur dioxide are significant in models that incorporate spatial autocorrelation. Accounting for autocorrelation also reduces the size and certainty of the sulfate effect on mortality when compared to results generated from Cox models where independent observations are assumed. Confidence limits for the sulfate relative risk include unity in models that simultaneously control for sulfur dioxide and autocorrelation. |
| Databáze: | OpenAIRE |
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