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Attributing the burden of cancer at work: three areas of concern when examining the example of shift-work

机译:归因于工作中的癌症负担:研究轮班工作的示例时应关注的三个领域

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摘要

This commentary intends to instigate discussions about epidemiologic estimates and their interpretation of attributable fractions (AFs) and the burden of disease (BOD) of cancers due to factors at workplaces. By examining recent work that aims to estimate the number of cancers attributable to shift-work in Britain, we suggest that (i) causal, (ii) practical and (iii) methodological areas of concern may deter us from attributable caseload estimations of cancers at this point in time. Regarding (i), such calculations may have to be avoided as long as we lack established causality between shift-work and the development of internal cancers. Regarding (ii), such calculations may have to be avoided as long as we can neither abandon shift-work nor identify personnel that may be unaffected by shift-work factors. Regarding (iii), there are at least four methodological pitfalls which are likely to make AF calculations uninterpretable at this stage. The four pitfalls are: (1) The use of Levin's 1953 formula in case of adjusted relative risks; (2) The use of broad definitions of exposure in calculations of AFs; (3) The non-additivity of AFs across different levels of exposure and covariables; (4) The fact that excess mortality counts are misleading due to the fact that a human being dies exactly once - a death may occur earlier or later, but a death cannot occur more than once nor can it be avoided altogether for any given individual. Overall, causal, practical and methodological areas of concern should be diligently considered when performing and interpreting AF or BOD computations which - at least at the present time - may not be defensible.
机译:这篇评论旨在激发有关流行病学估计及其因工作场所因素引起的癌症的归因分数(AFs)和疾病负担(BOD)的解释的讨论。通过研究旨在估计英国轮班工作引起的癌症数量的最新工作,我们建议(i)因果关系,(ii)实际问题和(iii)方法论关注的领域可能会阻止我们从这个时间点。关于(i),只要我们在轮班工作和内部癌症的发展之间缺乏确定的因果关系,就必须避免这种计算。关于(ii),只要我们既不能放弃轮班工作,也不能确定可能不受轮班因素影响的人员,就必须避免这种计算。关于(iii),至少有四个方法上的陷阱可能使现阶段的AF计算难以解释。四个陷阱是:(1)在调整相对风险的情况下使用Levin 1953年的公式; (2)在AF的计算中使用广泛的暴露定义; (3)房颤在不同暴露水平和协变量水平上的非可加性; (4)由于一个人仅会死一次,导致超额死亡率计数具有误导性这一事实-死亡可能早晚发生,但死亡不能发生超过一次,也不能完全避免给定任何个人。总体而言,在执行和解释AF或BOD计算时,应认真考虑因果关系,实践和方法论方面的问题,至少在目前,AF或BOD的计算尚无可辩驳。

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