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Challenges and recommendations on the conduct of systematic reviews of observational epidemiologic studies in environmental and occupational health


Systematic reviews are powerful tools for drawing causal inference for evidence-based decision-making. Published systematic reviews and meta-analyses of environmental and occupational epidemiology studies have increased dramatically in recent years; however, the quality and utility of published reviews are variable. Most methodologies were adapted from clinical epidemiology and have not been adequately modified to evaluate and integrate evidence from observational epidemiology studies assessing environmental and occupational hazards, especially in evaluating the quality of exposure assessments. Although many reviews conduct a systematic and transparent assessment for the potential for bias, they are often deficient in subsequently integrating across a body of evidence. A cohesive review considers the impact of the direction and magnitude of potential biases on the results, systematically evaluates important scientific issues such as study sensitivity and effect modifiers, identifies how different studies complement each other, and assesses other potential sources of heterogeneity. Given these challenges of conducting informative systematic reviews of observational studies, we provide a series of specific recommendations based on practical examples for cohesive evidence integration to reach an overall conclusion on a body of evidence to better support policy making in public health.

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Fig. 1: Elements of a well-conducted systematic review.


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The authors would like to thank the following people for their thoughtful reviews and comments on this manuscript, which have improved it greatly: Tara Hartley, Kathleen MacMahon, Robert Daniels, Kris Thayer, Tom Luben, Craig Steinmaus, Andrew Rooney, Christina Parks, and Abee Boyles.

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Correspondence to Ruth M. Lunn.

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The views expressed are those of the authors and do not necessarily represent the official position of the Office of Environmental Health Hazard Assessment, the California Environmental Protection Agency or the State of California, nor any of the U.S. Government (National Toxicology Program, U.S. Environmental Protection Agency, and the Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health) or International agencies (International Agency for Research on Cancer) with which some of the authors are affiliated.

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Arroyave, W.D., Mehta, S.S., Guha, N. et al. Challenges and recommendations on the conduct of systematic reviews of observational epidemiologic studies in environmental and occupational health. J Expo Sci Environ Epidemiol 31, 21–30 (2021).

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  • Environmental health policy
  • Exposure assessment
  • Alternatives assessment


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