Assessment and indirect adjustment for confounding by smoking in cohort studies using relative hazards models

Details

• Personal Author:
  Cole SR ; Laurier D ; Richardson DB ; Schubauer-Berigan, Mary K. ; Tchetgen ET
• Description:
  Workers' smoking histories are not measured in many occupational cohort studies. Here we discuss the use of negative control outcomes to detect and adjust for confounding in analyses that lack information on smoking. We clarify the assumptions necessary to detect confounding by smoking and the additional assumptions necessary to indirectly adjust for such bias. We illustrate these methods using data from 2 studies of radiation and lung cancer: the Colorado Plateau cohort study (1950-2005) of underground uranium miners (in which smoking was measured) and a French cohort study (1950-2004) of nuclear industry workers (in which smoking was unmeasured). A cause-specific relative hazards model is proposed for estimation of indirectly adjusted associations. Among the miners, the proposed method suggests no confounding by smoking of the association between radon and lung cancer - a conclusion supported by adjustment for measured smoking. Among the nuclear workers, the proposed method suggests substantial confounding by smoking of the association between radiation and lung cancer. Indirect adjustment for confounding by smoking resulted in an 18% decrease in the adjusted estimated hazard ratio, yet this cannot be verified because smoking was unmeasured. Assumptions underlying this method are described, and a cause-specific proportional hazards model that allows easy implementation using standard software is presented. [Description provided by NIOSH]
• Subjects:
  Epidemiology Hazardous Substances Lung Lung Diseases Neoplasms Occupational Exposure Occupational Health Radiation Respiratory System Respiratory Tract Diseases Safety Smokers Surveys And Questionnaires Tobacco Products Urogenital Diseases

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• Keywords:
  Analytical-models Author Keywords: Cohort Studies Cigarette-smoking Hazards Health-hazards Health-surveys Lung-cancer Lung Cancer Mathematical-models Occupational-hazards Pulmonary-system-disorders Reproductive-system-disorders Smoking Statistical-quality-control Surveillance-programs

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• ISSN:
  0002-9262
• Document Type:
  Text
• Genre:
  Journal Article
• Place as Subject:
  Massachusetts ; North Carolina ; Ohio ; OSHA Region 1 ; OSHA Region 4 ; OSHA Region 5
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  DSHEFS - Division of Surveillance, Hazard Evaluations, and Field Studies
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Volume:
  180
• Issue:
  9
• NIOSHTIC Number:
  nn:20045387
• Citation:
  Am J Epidemiol 2014 Nov; 180(9):933-940
• Contact Point Address:
  Dr. David B. Richardson, Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
• Email:
  david.richardson@unc.edu
• Federal Fiscal Year:
  2015
• NORA Priority Area:
  Manufacturing ; Mining
• Peer Reviewed:
  True
• Source Full Name:
  American Journal of Epidemiology
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:4171be91e33ad60b4ff43f04b02997799ac88b173d8542fdd21c3c435168b3627ae3973c394357d74a317ad2b2882bdf04fd6e63791335a1feaf58128e40ac9d
• Download URL:
  https://stacks.cdc.gov/view/cdc/200827/cdc_200827_DS1.pdf
• File Type:
  [PDF - 225.39 KB ]