ArticleJournal of exposure science & environmental epidemiology
Rethinking cumulative exposure in epidemiology, again.
Article in Journal of exposure science & environmental epidemiology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Duration-response association between occupational exposure and pancreatic cancer risk: meta-analysis.Occupational medicine (Oxford, England) · 2023Pooled it
- Impact of time-varying cumulative bevacizumab exposures on survival: re-analysis of data from randomized clinical trial in patients with metastatic colo-rectal cancer.BMC medical research methodology · 2021Trial
- Cumulative visceral fat burden and progression to advanced cardiovascular kidney metabolic syndrome in Chinese middle-aged and older adults.Scientific reports · 2026Article
- Association of cumulative systemic inflammation response index and all-cause mortality in adult with cardiovascular-kidney-metabolic syndrome stages 0-2: a prospective cohort study.BMC cardiovascular disorders · 2026Article
- Impact of triglyceride glucose-weight adjusted waist index and its cumulative exposure on stroke risk: a nationwide prospective cohort study.Lipids in health and disease · 2025Article
- Epidemiological criteria for causation applied to human health harms from RF-EMF exposure: Bradford Hill revisited.Frontiers in public health · 2025Review
- Association of cumulative resting heart rate exposure with rapid renal function decline: a prospective cohort study with 27,564 older adults.Journal of geriatric cardiology : JGC · 2023Article
- Understanding Training Load as Exposure and Dose.Sports medicine (Auckland, N.Z.) · 2023Article
- A Longitudinal Analysis of the Association Between Long-Term Exposure to Air Pollution and Cognitive Function Among Adults Aged 45 and Older in China.The journals of gerontology. Series B, Psychological sciences and social sciences · 2023Article
- Decrements in lung function and respiratory abnormalities associated with exposure to diacetyl and 2,3-pentanedione in coffee production workers.Frontiers in public health · 2022Article
- Individual quality and phenology mediate the effect of radioactive contamination on body temperature in Chernobyl barn swallows.Ecology and evolution · 2021Article
- Cumulative Exposure to Long Working Hours and Occurrence of Ischemic Heart Disease: Evidence From the CONSTANCES Cohort at Inception.Journal of the American Heart Association · 2020Article
- Lung function and paper dust exposure among workers in a soft tissue paper mill.International archives of occupational and environmental health · 2020Article
- Associations of Metrics of Peak Inhalation Exposure and Skin Exposure Indices With Beryllium Sensitization at a Beryllium Manufacturing Facility.Annals of work exposures and health · 2019Article
- Accumulated neighbourhood deprivation and coronary heart disease: a nationwide cohort study from Sweden.BMJ open · 2019Article
- Cumulative alcohol consumption and stroke risk in men.Journal of neurology · 2019Article
- A new approach for investigation of person-environment interaction effects in research involving health outcomes.European journal of ageing · 2019Article
- What to Do When Accumulated Exposure Affects Health but Only Its Duration Was Measured? A Case of Linear Regression.International journal of environmental research and public health · 2019Article
- Modeling the Complex Exposure History of Smoking in Predicting Bladder Cancer: A Pooled Analysis of 15 Case-Control Studies.Epidemiology (Cambridge, Mass.) · 2019Article
- Radiofrequency Electromagnetic Radiation and Memory Performance: Sources of Uncertainty in Epidemiological Cohort Studies.International journal of environmental research and public health · 2018Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The use of cumulative exposure, the product of intensity and duration, has enjoyed great popularity in epidemiology of chronic diseases despite numerous known caveats in its interpretation. We briefly review the history of use of cumulative exposure in epidemiology and propose an alternative method for relating time-integrated exposures to health risks. We argue, as others before us have, that cumulative exposure metrics obscures the interplay of exposure intensity and duration. We propose to use a computationally simple alternative in which duration and intensity of exposure are modelled as a main effect and their interaction, cumulative exposure, only be added if there is evidence of deviation from this additive model. We also consider the Lubin-Caporaso model of interplay of exposure intensity and duration. The impact of measurement error in intensity on model selection was also examined. The value of this conceptualization is demonstrated using a simulation study and further illustrated in the context of respiratory health and occupational exposure to latex dust. We demonstrate why cumulative exposure has been so popular because the cumulative exposure metric per se gives a robust answer to the existence of an association, regardless of the underlying true mechanism of disease. Treating cumulative exposure as the interaction of main effects of exposure duration and intensity enables epidemiologists to derive more information about mechanism of disease then fitting cumulative exposure metric by itself, and without the need to collect additional data. We propose that the practice of fitting duration, intensity and cumulative exposure separately to epidemiologic data should lead to conceptualization of cumulative exposure as interaction of main effects of duration and intensity of exposure.
Indexed as
Identifiers
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.