背景:持久性有机污染物(POPs)是一种环境化学物质,其特征是在自然界和人体中半衰期长,构成重大健康风险。曝光的概念,包括所有终生的环境暴露,强调了将POP作为混合物而不是孤立地研究的重要性。关于持久性有机污染物混合物对健康影响的证据越来越多,因此需要适当应用统计方法。
目的:我们旨在总结有关POP混合物整体效果的研究,确定混合方法的应用模式-用于调查混合物关联的统计方法-并通过案例研究说明,在综合POP混合物对健康影响的流行病学证据方面,当前面临的挑战。
方法:我们对PubMed和Embase在2011年1月至2023年4月期间发表的流行病学研究进行了系统的文献检索。
结果:我们纳入了240项符合我们资格标准的研究。126项研究仅针对全氟烷基和多氟烷基物质(PFAS)混合物,40人在混合物分析中分析了三类或三类以上的持久性有机污染物。我们确定了23种独特的混合方法,用于估计持久性有机污染物混合物的总体影响,使用贝叶斯内核机器回归(BKMR),一种响应面建模,是最常见的。此外,22.9%的研究使用了多种方法的组合,包括响应面建模,索引建模,降维,和潜在变量模型。最广泛探索的健康结果类别是体重和出生尺寸(n=43),和神经系统的结果(n=41)。在PFAS混合物和出生体重的案例研究中,12项研究显示负相关,而4显示空结果,和2显示正相关。
■本范围界定综述使用统计方法巩固了有关POP混合物整体影响的现有文献。通过提供全面的概述,我们的研究阐明了该领域的知识现状,并强调了以POP混合物为重点的流行病学研究中普遍存在的方法学障碍。通过这种分析,我们的目标是引导未来的研究方向,促进对评估POP混合物对健康的影响所涉及的复杂动态的更细致的理解。我们的工作为正在进行的化学暴露研究做出了重大贡献。
BACKGROUND: Persistent organic pollutants (POPs) are environmental chemicals characterized by long half-lives in nature and human bodies, posing significant health risks. The concept of the exposome, encompassing all lifetime environmental exposures, underscores the importance of studying POP as mixtures rather than in isolation. The increasing body of evidence on the health impacts of POP
mixtures necessitates the proper application of statistical methods.
OBJECTIVE: We aimed to summarize studies on the overall effects of POP
mixtures, identify patterns in applications of mixture methods-statistical methods for investigating the association of mixtures-and highlight current challenges in synthesizing epidemiologic evidence of POP
mixtures on health effects as illustrated through a case study.
METHODS: We conducted a systematic literature search on PubMed and Embase for epidemiological studies published between January 2011 and April 2023.
RESULTS: We included 240 studies that met our eligibility criteria. 126 studies focused on per- and polyfluoroalkyl substances (PFAS) mixtures only, while 40 analyzed three or more classes of POPs in mixture analyses. We identified 23 unique mixture methods used to estimate the overall effects of POP
mixtures, with Bayesian Kernel Machine Regression (BKMR), a type of response-surface modeling, being the most common. Additionally, 22.9% of studies used a combination of methods, including response-surface modeling, index modeling, dimension reduction, and latent variable models. The most extensively explored health outcome category was body weight and birth sizes (n = 43), and neurological outcomes (n = 41). In the case study of PFAS
mixtures and birth weight, 12 studies showed negative associations, while 4 showed null results, and 2 showed positive associations.
UNASSIGNED: This scoping review consolidates the existing literature on the overall effects of POP mixtures using statistical methods. By providing a comprehensive overview, our study illuminates the present landscape of knowledge in this field and underscores the methodological hurdles prevalent in epidemiological studies focused on POP mixtures. Through this analysis, we aim to steer future research directions, fostering a more nuanced comprehension of the intricate dynamics involved in assessing the health effects of POP mixtures. Our work stands as a significant contribution to the ongoing exploration of the chemical exposome.