In their response, Doss (2018) argued mainly on standardised incidence ratios (SIRs) for all-cause mortality and the specific SIR based on the observed all cancer cases (observed), which was based on the exposed cohort divided by the expected cancer cases, itself based on a general population throughout Taiwan. Unfortunately, the argued expected value calculated by the authors did not take into account the potential social-economic effects and cannot rule out a healthy resident effect, which potentially incurred a lower expected number of cancer cases by the authors. While SIRs were widely used in environmental studies when individuals’ exposures were not available, SIRs assumed that the general population was an appropriate equivalent reference population and the social-economic and behaviour variables were similar or not available. However, in this cohort study, the majority of the Taiwan RBC cohort resided and moved into newly built apartments and building complexes, or studied in new school buildings, in the metropolitan capital Taipei during early 1980; an economic booming period in Taiwan. Therefore, the majority of the exposed had relatively better socio-economic and educational status than the average in Taiwan. After the incidences were disclosed, the government provided health examinations for the exposed residents and students, and the registered exposed cohort were assumed as having higher healthy literacy.
Date:
2018-03
Relation:
British Journal of Cancer. 2018 Mar;118(5):Article number e10.
