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For example, control-fathers were case-control status. Only industrial groups with 10 or more workers are shown in Table. Three missing for health care and social assistance sectors.
Since the referent group introduce bias in studies of paternal occupation and neu- for risk estimates included fathers who worked in occupa- ral tube defects, oral clefts, and other defects for which tions other than the occupational group of interest, these insufficient folic acid is a risk factor. These findings under- occupational groups that were more likely to be missing score the need for caution when interpreting associations on the birth certificate would be underrepresented in the of parental occupation and birth defects based on birth referent group for the controls.
This bias could result in certificate information. Choice of referent group might risk estimates farther away from the null even though the lead to overestimates as well as underestimates of associa- misclassification of paternal occupation by case control tions if missing occupations vary by case-control status. In the present study, paternal pro- ing occupations were essentially the same between the fessional or managerial occupations that require more for- two groups We also looked at the mal education were less likely to have missing effect of using fathers in professional or management information on the birth certificate than occupations occupations as a referent group; in the present study, these requiring less education such as construction or food serv- groups had few missing data on the birth certificate and ice occupations.
Very few birth certificates were missing showed substantial to almost perfect agreement with the information regarding maternal occupation or industrial interview. With these fathers as the referent group, pater- sector, but, as already discussed, mothers were frequently nal occupations in installation, maintenance, and repair misclassified as homemakers. This study had several limitations including use of the maternal interview as the gold standard to evaluate the Furthermore, the proportion of missing paternal occupa- quality of paternal occupational information on the birth tions on the birth certificate varied by reported maternal certificate.
In telephone interviews, mothers provided folic acid use during the periconceptional period. Schnitzer et al. However, mothers in the Atlanta study were interviewed 2 Conclusion to 15 years after the index birth [20] in contrast to the In conclusion, linkage of birth defect registry cases with NBDPS mothers who are interviewed 6 weeks to 2 years their respective birth certificates and parental occupation after the index birth.
Therefore, it is likely that the moth- shows some promise in surveillance of reproductive haz- ers' reports of fathers' occupations in the NBDPS are more ards in the workplace.
The findings in this study also indi- accurate than those of the — Atlanta birth cate that the quality of this information varies by parental cohort mothers from which Schnitzer et al. Misclassification of mothers as study data, though some misclassification will still homemaker or otherwise unemployed on the birth certif- remain.
Length of time from pregnancy to interview and icate and missing information for paternal occupation multiple jobs during the exposure period of interest may may be problematic. The overall agreement between the increase errors in maternal recall of paternal occupations. Because of these limi- tion in the fetal death records because this information tations, occupational surveillance findings based on the was not available in the computerized fetal death record birth certificate should be followed up with studies based files in Texas.
Although this exclusion amounted to only on parental interview and industrial hygiene assessments 20 cases in this study, it would be important to include of workplace exposures. Public Health Rep , Suppl 1 Environ Health Perspect , AA LS and PHL partic- Am Ind Hyg ipated in the design of the study, acquired the relevant Assoc J , PEPI Version 3.
All authors read and Fleiss JL: The measurement of interrater agreement. In Statis- approved the final manuscript. Biometrics , Development of study databases, data analyses, and preparation of the man-
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