Exposure Errors due to Inaccurate Residential Addresses and their Impact on Epidemiological Associations: Evidence from a National Neonate Dataset

Abstract

Background and aim: Studies assessing the associations between prenatal air pollution exposures and birth outcomes commonly use maternal addresses at the time of delivery as a proxy for residency throughout pregnancy. In large-scale studies, administrative addresses are widely used as a proxy for maternal residency throughout pregnancy under the assumption that they are up-to-date. However, if residential mobility is not reported, inaccurate addresses may introduce exposure estimation errors that might affect the study results. The aim of this study is to examine the use of the Israeli population registry addresses to assign exposure estimations and evaluates the impact of inaccurate addresses on estimates and association measures of prenatal exposures with congenital hypothyroidism. Methods: We used morbidity data from the national program for neonatal screening for 2009-2015 and address data from two sources. We selected neonates with geocoded addresses from both sources (N=685,491) and developed an address comparison algorithm. Next, we assigned neonates with exposures, evaluated exposure assessment differences, and used multivariable logistic regression models to assess the impact that these differences have on association measures. Results: We found that most of the exposure differences between neonates with addresses from both sources were around zero and had a leptokurtic distribution density, with most values being zero. Additionally, associations between exposure and congenital hypothyroidism were comparable, regardless of address source and when we limited the model to neonates with identical addresses. . Conclusions: For our study population and based on the exposure estimation models we used, we found that ignoring residential inaccuracies results in only a small bias of the associations towards the null. The results validate the use of administrative residential addresses for exposure assessment in studies of PM, NO2, and NOX exposures when more detailed residential data are not available. Keywords: Exposure errors, particulate matter, nitrogen oxides, congenital hypothyroidism.