Evidence map›Paper›PMID 32924579›Full record

ArticleEnvironmental health perspectives2020

Risk of Bias Assessments and Evidence Syntheses for Observational Epidemiologic Studies of Environmental and Occupational Exposures: Strengths and Limitations.

Kyle Steenland, M K Schubauer-Berigan, R Vermeulen, R M Lunn, K Straif, S Zahm, P Stewart, W D Arroyave, S S Mehta, N Pearce

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PubMed Full text at PMC Publisher
In one paragraph

Article in Environmental health perspectives, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 13 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
37citing papers in PubMed, 13 pooled it
–field-weighted citation impact
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

37 citing papers in PubMed, 13 syntheses or guidelines pooled it.

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  20. Increasing the utility of epidemiologic studies as key evidence in chemical risk assessment.Toxicological sciences : an official journal of the Society of Toxicology · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Kyle SteenlandRollins School of Public Health, Emory University, Atlanta, Georgia, USA.
M K Schubauer-BeriganInternational Agency for Research on Cancer (IARC), Lyon, France.
R VermeulenInstitute for Risk Assessment Science, University of Utrecht, Utrecht, Netherlands.
R M LunnDivision of the National Toxicology Program (NTP), NIEHS, Research Triangle Park, North Carolina, USA.
K StraifGlobal Observatory on Pollution and Health, Boston College, Boston, Massachusetts, USA.
S ZahmShelia Zahm Consulting, Hermon, Maine, USA.
P StewartStewart Exposure Assessments, LLC, Arlington, Virginia, USA.
W D ArroyaveIntegrated Laboratory Systems, Morrisville, North Carolina, USA.
S S MehtaDivision of the National Toxicology Program (NTP), NIEHS, Research Triangle Park, North Carolina, USA.
N PearceLondon School of Hygiene and Tropical Medicine, London, UK.

Funding

World Health Organization 001
6 · The paper itself

Abstract

backgroundIncreasingly, risk of bias tools are used to evaluate epidemiologic studies as part of evidence synthesis (evidence integration), often involving meta-analyses. Some of these tools consider hypothetical randomized controlled trials (RCTs) as gold standards.

methodsWe review the strengths and limitations of risk of bias assessments, in particular, for reviews of observational studies of environmental exposures, and we also comment more generally on methods of evidence synthesis.

resultsAlthough RCTs may provide a useful starting point to think about bias, they do not provide a gold standard for environmental studies. Observational studies should not be considered inherently biased vs. a hypothetical RCT. Rather than a checklist approach when evaluating individual studies using risk of bias tools, we call for identifying and quantifying possible biases, their direction, and their impacts on parameter estimates. As is recognized in many guidelines, evidence synthesis requires a broader approach than simply evaluating risk of bias in individual studies followed by synthesis of studies judged unbiased, or with studies given more weight if judged less biased. It should include the use of classical considerations for judging causality in human studies, as well as triangulation and integration of animal and mechanistic data.

conclusionsBias assessments are important in evidence synthesis, but we argue they can and should be improved to address the concerns we raise here. Simplistic, mechanical approaches to risk of bias assessments, which may particularly occur when these tools are used by nonexperts, can result in erroneous conclusions and sometimes may be used to dismiss important evidence. Evidence synthesis requires a broad approach that goes beyond assessing bias in individual human studies and then including a narrow range of human studies judged to be unbiased in evidence synthesis. https://doi.org/10.1289/EHP6980.

Indexed as

Environmental ExposureBiasEpidemiologic StudiesHumansOccupational ExposureResearch Design

Identifiers

PMID32924579
PMCPMC7489341

What OpenQuestion holds

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Registered trials

None linked

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.