KSE
Search
- Page Path
- HOME > Search
Systematic Review
- Confounding and the healthy worker survivor effect in studies of medical radiation workers: a systematic review of methodological approaches
- Eun Jung Park, Kyoungyeol Yuk, Jaeho Jeong, Won Jin Lee
- Epidemiol Health. 2026;48:e2026009. Published online February 4, 2026
- DOI: https://doi.org/10.4178/epih.e2026009
- 5,805 View
- 118 Download
- 1 Web of Science
- 1 Crossref
-
Abstract
Summary
PDF
Supplementary Material -
AbstractConfounding and the healthy worker survivor effect (HWSE) represent major methodological challenges in epidemiology, particularly in studies of low-dose exposures, where effect sizes are small and risk estimates can be readily distorted by bias. This systematic review aimed to summarize the methods used to adjust for confounding and the HWSE in studies of medical radiation workers. We systematically searched PubMed and Embase for studies of medical radiation workers from inception through June 30, 2025. Studies reporting excess risk estimates for any health outcomes associated with occupational radiation exposure were included. Study selection followed the PECO (Population, Exposure, Comparator, Outcome) criteria, and data were synthesized descriptively. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered in PROSPERO (CRD42024589851). Sixteen eligible studies from 3 countries were identified, all of which were rated as high quality. To control for confounding, regression was used in all studies, followed by stratification (62.5%) and restriction (18.8%). Age, sex, and birth year were adjusted for in all models, with smoking being the next most frequently controlled variable. To mitigate the HWSE, only a single approach, adjustment for employment characteristics, was identified, and it was applied in 3 studies (18.8%). No other approaches, including restriction or g-methods, were employed. Although confounding is generally addressed using conventional analytical approaches, the HWSE has rarely been considered in studies of medical radiation workers. More comprehensive strategies that explicitly account for the HWSE are needed to improve the validity of risk estimates, particularly in low-dose occupational studies.
-
SummaryKorean summary
교란 및 건강근로자 생존효과는 역학 연구에서 해결해야 할 중요한 과제이며, 특히 저노출 연구에서는 효과 크기가 상대적으로 작아 이러한 영향에 더욱 취약하다. 연구 결과, 의료방사선종사자 연구에서 교란은 회귀분석 및 층화와 같은 전통적인 방법을 통해 적절히 보정되고 있지만, 건강근로자 생존효과를 줄이기 위한 방법은 대부분의 연구에서 적용되지 않고 있다. 향후 역학 연구에서는 보다 정확한 위험도 평가를 위해 건강근로자 생존효과를 줄이기 위한 다양한 방법의 적용이 필요하다.Key Message
Confounding and the healthy worker survivor effect (HWSE) are major methodological challenges in epidemiology, particu- larly in studies involving low-dose exposure. Although confounding is generally considered to have only a limited impact in occupational epidemiology, a variety of analytical methods have nonetheless been applied to control it. In contrast, the HWSE, despite being widely recognized as a major source of bias, has rarely been mitigated in practice. More comprehensive strat- egies that explicitly account for the HWSE are needed to improve the validity of risk estimates. -
Citations
Citations to this article as recorded by
- Cardiovascular composite events and the healthy worker effect among noise-exposed workers: a retrospective cohort study
Jiahui Liu, Qi Li, Jiamin Liu
Frontiers in Public Health.2026;[Epub] CrossRef
- Cardiovascular composite events and the healthy worker effect among noise-exposed workers: a retrospective cohort study
First
Prev
