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Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution

BACKGROUND: There is a long tradition in environmental health of using frameworks for evidence synthesis, such as those of the U.S. Environmental Protection Agency for its Integrated Science Assessments and the International Agency for Research on Cancer Monographs. The framework, Grading of Recomme...

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Autores principales: Boogaard, Hanna, Atkinson, Richard W., Brook, Jeffrey R., Chang, Howard H., Hoek, Gerard, Hoffmann, Barbara, Sagiv, Sharon K., Samoli, Evangelia, Smargiassi, Audrey, Szpiro, Adam A., Vienneau, Danielle, Weuve, Jennifer, Lurmann, Frederick W., Forastiere, Francesco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Environmental Health Perspectives 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664749/
https://www.ncbi.nlm.nih.gov/pubmed/37991444
http://dx.doi.org/10.1289/EHP11532
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author Boogaard, Hanna
Atkinson, Richard W.
Brook, Jeffrey R.
Chang, Howard H.
Hoek, Gerard
Hoffmann, Barbara
Sagiv, Sharon K.
Samoli, Evangelia
Smargiassi, Audrey
Szpiro, Adam A.
Vienneau, Danielle
Weuve, Jennifer
Lurmann, Frederick W.
Forastiere, Francesco
author_facet Boogaard, Hanna
Atkinson, Richard W.
Brook, Jeffrey R.
Chang, Howard H.
Hoek, Gerard
Hoffmann, Barbara
Sagiv, Sharon K.
Samoli, Evangelia
Smargiassi, Audrey
Szpiro, Adam A.
Vienneau, Danielle
Weuve, Jennifer
Lurmann, Frederick W.
Forastiere, Francesco
author_sort Boogaard, Hanna
collection PubMed
description BACKGROUND: There is a long tradition in environmental health of using frameworks for evidence synthesis, such as those of the U.S. Environmental Protection Agency for its Integrated Science Assessments and the International Agency for Research on Cancer Monographs. The framework, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), was developed for evidence synthesis in clinical medicine. The U.S. Office of Health Assessment and Translation (OHAT) elaborated an approach for evidence synthesis in environmental health building on GRADE. METHODS: We applied a modified OHAT approach and a broader “narrative” assessment to assess the level of confidence in a large systematic review on traffic-related air pollution and health outcomes. DISCUSSION: We discuss several challenges with the OHAT approach and its implementation and suggest improvements for synthesizing evidence from observational studies in environmental health. We consider the determination of confidence using a formal rating scheme of up- and downgrading of certain factors, the treatment of every factor as equally important, and the lower initial confidence rating of observational studies to be fundamental issues in the OHAT approach. We argue that some observational studies can offer high-confidence evidence in environmental health. We note that heterogeneity in magnitude of effect estimates should generally not weaken the confidence in the evidence, and consistency of associations across study designs, populations, and exposure assessment methods may strengthen confidence in the evidence. We mention that publication bias should be explored beyond statistical methods and is likely limited when large and collaborative studies comprise most of the evidence and when accrued over several decades. We propose to identify possible key biases, their most likely direction, and their potential impacts on the results. We think that the OHAT approach and other GRADE-type frameworks require substantial modification to align better with features of environmental health questions and the studies that address them. We emphasize that a broader, “narrative” evidence assessment based on the systematic review may complement a formal GRADE-type evaluation. https://doi.org/10.1289/EHP11532
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spelling pubmed-106647492023-11-22 Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution Boogaard, Hanna Atkinson, Richard W. Brook, Jeffrey R. Chang, Howard H. Hoek, Gerard Hoffmann, Barbara Sagiv, Sharon K. Samoli, Evangelia Smargiassi, Audrey Szpiro, Adam A. Vienneau, Danielle Weuve, Jennifer Lurmann, Frederick W. Forastiere, Francesco Environ Health Perspect Commentary BACKGROUND: There is a long tradition in environmental health of using frameworks for evidence synthesis, such as those of the U.S. Environmental Protection Agency for its Integrated Science Assessments and the International Agency for Research on Cancer Monographs. The framework, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), was developed for evidence synthesis in clinical medicine. The U.S. Office of Health Assessment and Translation (OHAT) elaborated an approach for evidence synthesis in environmental health building on GRADE. METHODS: We applied a modified OHAT approach and a broader “narrative” assessment to assess the level of confidence in a large systematic review on traffic-related air pollution and health outcomes. DISCUSSION: We discuss several challenges with the OHAT approach and its implementation and suggest improvements for synthesizing evidence from observational studies in environmental health. We consider the determination of confidence using a formal rating scheme of up- and downgrading of certain factors, the treatment of every factor as equally important, and the lower initial confidence rating of observational studies to be fundamental issues in the OHAT approach. We argue that some observational studies can offer high-confidence evidence in environmental health. We note that heterogeneity in magnitude of effect estimates should generally not weaken the confidence in the evidence, and consistency of associations across study designs, populations, and exposure assessment methods may strengthen confidence in the evidence. We mention that publication bias should be explored beyond statistical methods and is likely limited when large and collaborative studies comprise most of the evidence and when accrued over several decades. We propose to identify possible key biases, their most likely direction, and their potential impacts on the results. We think that the OHAT approach and other GRADE-type frameworks require substantial modification to align better with features of environmental health questions and the studies that address them. We emphasize that a broader, “narrative” evidence assessment based on the systematic review may complement a formal GRADE-type evaluation. https://doi.org/10.1289/EHP11532 Environmental Health Perspectives 2023-11-22 /pmc/articles/PMC10664749/ /pubmed/37991444 http://dx.doi.org/10.1289/EHP11532 Text en https://ehp.niehs.nih.gov/about-ehp/licenseEHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted.
spellingShingle Commentary
Boogaard, Hanna
Atkinson, Richard W.
Brook, Jeffrey R.
Chang, Howard H.
Hoek, Gerard
Hoffmann, Barbara
Sagiv, Sharon K.
Samoli, Evangelia
Smargiassi, Audrey
Szpiro, Adam A.
Vienneau, Danielle
Weuve, Jennifer
Lurmann, Frederick W.
Forastiere, Francesco
Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution
title Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution
title_full Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution
title_fullStr Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution
title_full_unstemmed Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution
title_short Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution
title_sort evidence synthesis of observational studies in environmental health: lessons learned from a systematic review on traffic-related air pollution
topic Commentary
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664749/
https://www.ncbi.nlm.nih.gov/pubmed/37991444
http://dx.doi.org/10.1289/EHP11532
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