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

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Title: Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution.
Authors: Boogaard, Hanna1 jboogaard@healtheffects.org, Atkinson, Richard W.2, Brook, Jeffrey R.3, Chang, Howard H.4, Hoek, Gerard5, Hoffmann, Barbara6, Sagiv, Sharon K.7, Samoli, Evangelia8, Smargiassi, Audrey9, Szpiro, Adam A.10, Vienneau, Danielle11,12, Weuve, Jennifer13, Lurmann, Frederick W.14, Forastiere, Francesco15
Source: Environmental Health Perspectives. Nov2023, Vol. 131 Issue 11, p115002-1-115002-10. 10p.
Subject Terms: *Air pollution emissions prevention, *Emissions (Air pollution), *Pollutants, *Public health, *Environmental health, *Toxicology, *Environmental exposure, Conceptual structures, Risk assessment, Statistical models
Company/Entity: United States. Environmental Protection Agency
Abstract: 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. [ABSTRACT FROM AUTHOR]
Copyright of Environmental Health Perspectives is the property of National Institute of Environmental Health Sciences and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution.
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  Data: <searchLink fieldCode="AR" term="%22Boogaard%2C+Hanna%22">Boogaard, Hanna</searchLink><relatesTo>1</relatesTo><i> jboogaard@healtheffects.org</i><br /><searchLink fieldCode="AR" term="%22Atkinson%2C+Richard+W%2E%22">Atkinson, Richard W.</searchLink><relatesTo>2</relatesTo><br /><searchLink fieldCode="AR" term="%22Brook%2C+Jeffrey+R%2E%22">Brook, Jeffrey R.</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Chang%2C+Howard+H%2E%22">Chang, Howard H.</searchLink><relatesTo>4</relatesTo><br /><searchLink fieldCode="AR" term="%22Hoek%2C+Gerard%22">Hoek, Gerard</searchLink><relatesTo>5</relatesTo><br /><searchLink fieldCode="AR" term="%22Hoffmann%2C+Barbara%22">Hoffmann, Barbara</searchLink><relatesTo>6</relatesTo><br /><searchLink fieldCode="AR" term="%22Sagiv%2C+Sharon+K%2E%22">Sagiv, Sharon K.</searchLink><relatesTo>7</relatesTo><br /><searchLink fieldCode="AR" term="%22Samoli%2C+Evangelia%22">Samoli, Evangelia</searchLink><relatesTo>8</relatesTo><br /><searchLink fieldCode="AR" term="%22Smargiassi%2C+Audrey%22">Smargiassi, Audrey</searchLink><relatesTo>9</relatesTo><br /><searchLink fieldCode="AR" term="%22Szpiro%2C+Adam+A%2E%22">Szpiro, Adam A.</searchLink><relatesTo>10</relatesTo><br /><searchLink fieldCode="AR" term="%22Vienneau%2C+Danielle%22">Vienneau, Danielle</searchLink><relatesTo>11,12</relatesTo><br /><searchLink fieldCode="AR" term="%22Weuve%2C+Jennifer%22">Weuve, Jennifer</searchLink><relatesTo>13</relatesTo><br /><searchLink fieldCode="AR" term="%22Lurmann%2C+Frederick+W%2E%22">Lurmann, Frederick W.</searchLink><relatesTo>14</relatesTo><br /><searchLink fieldCode="AR" term="%22Forastiere%2C+Francesco%22">Forastiere, Francesco</searchLink><relatesTo>15</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22Environmental+Health+Perspectives%22">Environmental Health Perspectives</searchLink>. Nov2023, Vol. 131 Issue 11, p115002-1-115002-10. 10p.
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  Data: *<searchLink fieldCode="DE" term="%22Air+pollution+emissions+prevention%22">Air pollution emissions prevention</searchLink><br />*<searchLink fieldCode="DE" term="%22Emissions+%28Air+pollution%29%22">Emissions (Air pollution)</searchLink><br />*<searchLink fieldCode="DE" term="%22Pollutants%22">Pollutants</searchLink><br />*<searchLink fieldCode="DE" term="%22Public+health%22">Public health</searchLink><br />*<searchLink fieldCode="DE" term="%22Environmental+health%22">Environmental health</searchLink><br />*<searchLink fieldCode="DE" term="%22Toxicology%22">Toxicology</searchLink><br />*<searchLink fieldCode="DE" term="%22Environmental+exposure%22">Environmental exposure</searchLink><br /><searchLink fieldCode="DE" term="%22Conceptual+structures%22">Conceptual structures</searchLink><br /><searchLink fieldCode="DE" term="%22Risk+assessment%22">Risk assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Statistical+models%22">Statistical models</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22United+States%2E+Environmental+Protection+Agency%22">United States. Environmental Protection Agency</searchLink>
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  Label: Abstract
  Group: Ab
  Data: 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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Environmental Health Perspectives is the property of National Institute of Environmental Health Sciences and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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RecordInfo BibRecord:
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    Identifiers:
      – Type: doi
        Value: 10.1289/EHP11532
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      – Code: eng
        Text: English
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        PageCount: 10
        StartPage: 115002-1
    Subjects:
      – SubjectFull: Air pollution emissions prevention
        Type: general
      – SubjectFull: Emissions (Air pollution)
        Type: general
      – SubjectFull: Pollutants
        Type: general
      – SubjectFull: Public health
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      – SubjectFull: Environmental health
        Type: general
      – SubjectFull: Toxicology
        Type: general
      – SubjectFull: Environmental exposure
        Type: general
      – SubjectFull: Conceptual structures
        Type: general
      – SubjectFull: Risk assessment
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      – SubjectFull: Statistical models
        Type: general
      – SubjectFull: United States. Environmental Protection Agency
        Type: general
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      – TitleFull: Evidence Synthesis of Observational Studies in Environmental Health: Lessons Learned from a Systematic Review on Traffic-Related Air Pollution.
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              Text: Nov2023
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