By Paul Wilkinson
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Extra resources for Environmental Epidemiology (Understanding Public Health)
Air pollution and daily mortality in London: 1987–92 Objective – To investigate whether outdoor air pollution levels in London influence daily mortality. Design – Poisson regression analysis of daily counts of deaths, with adjustment for effects of secular trend, seasonal and other cyclical factors, day of the week, holidays, influenza epidemic, temperature, humidity, and autocorrelation, from April 1987 to March 1992. Pollution variables were particles (black smoke), sulphur dioxide, ozone, and nitrogen dioxide, lagged 0–3 days.
Counts of health outcome data, though often approximately Poisson distributed, are frequently ‘overdispersed’, which means that they have more variation than predicted by the Poisson model. This can be allowed for by using a simple modification of the method. • Shape of exposure-response function. This is usually assumed to be linear in the case of air pollution, which allows for easy quantification of effect sizes. • Lags. Pollution on any given day may affect health on that same day, but also the day after, and the day after that, etc.
As described in Chapter 1, protocols and guidelines have been developed by agencies such as the US Communicable Disease Center. These generally propose staged assessments, beginning with the rapid assessment of whether there is a prima facie case of an excess, followed by review of the reported cases, and then formal epidemiological study. The investigation can be stopped at any stage if the evidence and/or public health context indicate that there is little merit in proceeding further. Because p-values are of limited use in such studies, greater weight needs to be given to factors such as the specificity of effect, the plausibility of the exposure-disease link(s), dose-response relationships, and the pattern of findings in relation to the timing and level of exposure.
Environmental Epidemiology (Understanding Public Health) by Paul Wilkinson