exposureeffectsinchronicairpollutionstudieswehaveana.doc

The interpretation of exposure effect estimates in chronic air pollution studies Sebastien J-P.A. Haneuse, PhD,1 Jon Wakefield PhD, 2,3 Lianne Sheppard, 2,4 PhD. 1 Center for Health Studies, Group Health Cooperative, Seattle, WA. 2 Department of Biostatistics, University of Washington, Seattle, WA. 3 Department of Statistics, University of Washington, Seattle, WA. 4 Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA. Institutional Address: Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1448, USA. Corresponding author: Sebastien J-P.A. Haneuse, Center for Health Studies, Group Health Cooperative, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1448, USA. Tel: (206) 285 2005 Fax: (206) 287 2871 e-mail: haneuse.s@ghc.orgRunning title: Interpretation of chronic effects studies. Keywords: Air pollution, chronic effects studies, Cox PH regression, exposure, model misspecification. Acknowledgements: This work was funded by UW/EPA NW Research Center for Particulate Air Pollution and Health (CR827355), and the second author was supported by grant R01 CA095994 from the National Institutes of Health. Outline of section headers: Abstract. Ecological exposure assessment. Introduction. Cox’s proportional hazards model. Individual-level models. Insensitivity analysis. Discussion.Abstract In this article, we consider the interpretation of regression parameters used to represent “chronic” or “long-term” air pollution exposure effects. Studies that investigate such effects have generally been semi-ecological; outcomes and confounder/adjustment variables are available at the level of the individual, while exposures are only observed at the aggregate or group level. The use of this design has been driven by the lack of adequate long-term individual-level air pollution information. We assume that primary interest lies in understanding individual-le