Influence of exposure measurement errors on results from epidemiologic studies of different designs

In epidemiologic studies of health effects of air pollution, measurements or models are used to estimate exposure. Exposure estimates have errors that propagate to effect estimates in exposure-response models. We critically evaluate how types of exposure measurement error influenced bias and precision of effect estimates to understand conditions affecting interpretation of exposure-response models for epidemiologic studies of exposure to PM_2.5, NO₂, and SO₂. We reviewed available literature on exposure measurement error for time-series and long-term exposure epidemiology studies. For time-series studies, time-activity error (daily exposure concentration did not account for variation in exposure due to time-activity during a day) and nonambient (indoor) sources negatively biased the effect estimates and increased standard error, so uncertainty grew with increasing bias while underestimating the true health effect in these studies. Spatial error (deviation between true exposure concentration at an individual's location and concentration at a receptor) was ascribed to negatively biased effect estimates in most cases. Positive bias occurred for spatially variable pollutants when the variance of error correlated with the exposure estimate. For long-term exposure studies, most spatial errors did not bias the effect estimate. For both time-series and long-term exposure studies reviewed, large uncertainties were observed when exposure concentration was modeled with low spatial and temporal resolution for a spatially variable pollutant.