Bias and power in group-based epidemiologic studies of low-back pain exposure and outcome: effects of study size and exposure measurement efforts

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Coenen, PieterCurtin University, Perth, Australia; VU University Amsterdam, the Netherlands; Body@Work, Research Center on Physical Activity, Work and Health, the Netherlands (author)

Bias and power in group-based epidemiologic studies of low-back pain exposure and outcome : effects of study size and exposure measurement efforts

Article/chapterEnglish2015

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2014-11-27
Oxford University Press (OUP),2015
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LIBRIS-ID:oai:DiVA.org:hig-14246
https://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-14246URI
https://doi.org/10.1093/annhyg/meu102DOI

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Language:English
Summary in:English

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Subject category:art swepub-publicationtype

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Objectives: Exposure-outcome studies, for instance on work-related low-back pain (LBP), often classify workers into groups for which exposures are estimated from measurements on a sample of workers within or outside the specific study. The present study investigated the influence on bias and power in exposure-outcome associations of the sizes of the total study population and the sample used to estimate exposures.Methods: At baseline, lifting, trunk flexion, and trunk rotation were observed for 371 of 1131 workers allocated to 19 a-priori defined occupational groups. LBP (dichotomous) was reported by all workers during three years of follow-up. All three exposures were associated with LBP in this parent study (p<0.01).All 21 combinations of n=10,20,30 workers per group with an outcome, and k=1,2,3,5,10,15,20 workers actually being observed were investigated using bootstrapping, repeating each combination 10,000 times. Odds ratios (OR) with p-values were determined for each of these virtual studies. Average OR and statistical power (p<0.05 and p<0.01) was determined from the bootstrap distributions at each (n,k) combination.Results: For lifting and flexed trunk, studies including n≥20 workers, with k≥5 observed, led to an almost unbiased OR and a power >0.80 (p-level 0.05). A similar performance required n≥30 workers for rotated trunk. Small numbers of observed workers (k) resulted in biased OR, while power was, in general, more sensitive to the total number of workers (n).Conclusions: In epidemiologic studies using a group-based exposure assessment strategy, statistical performance may be sufficient if outcome is obtained from a reasonably large number of workers, even if exposure is estimated from only few workers per group.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Arbetsmedicin och miljömedicin hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Occupational Health and Environmental Health hsv//eng
epidemiology
ergonomics
exposure
exposure assessment
group-based measurement strategy
low-back pain
musculoskeletal injury
precision

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Mathiassen, Svend ErikHögskolan i Gävle,Arbetshälsovetenskap,Centrum för belastningsskadeforskning(Swepub:hig)smn (author)
Kingma, IdsartVU University Amsterdam, the Netherlands; Body@Work, Research Center on Physical Activity, Work and Health, the Netherlands (author)
Boot, CécileBody@Work, Research Center on Physical Activity, Work and Health, the Netherlands; EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands (author)
Bongers, PaulienBody@Work, Research Center on Physical Activity, Work and Health, the Netherlands; TNO Healthy Living, Hoofddorp, the Netherlands (author)
van Dieën, JaapVU University Amsterdam, the Netherlands; King Abdulaziz University,Jeddah, Saudi Arabia (author)
Curtin University, Perth, Australia; VU University Amsterdam, the Netherlands; Body@Work, Research Center on Physical Activity, Work and Health, the NetherlandsArbetshälsovetenskap (creator_code:org_t)

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In:Annals of Occupational Hygiene: Oxford University Press (OUP)59:4, s. 439-4540003-48781475-3162

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By the author/editor: Coenen, Pieter; Mathiassen, Sven ...; Kingma, Idsart; Boot, Cécile; Bongers, Paulien; van Dieën, Jaap

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