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• W2049209736 abstract "The conclusions concerning the relationship of air pollution and lung cancer mortality in a paper in the previous issue of this Journal (Ashley, 1969) are opposite to those reported in the preceding issue (Gardner, Crawford and Morris, 1969) and in other studies reported earlier by many authors. Workers in the field of epidemiology are well aware of the importance of looking at their data correctly and of the difficulties of placing aetiological interpretations on associations found between environmental factors and mortality rates. Errors that arise from not doing so are only too well demonstrated in the paper by Ashley (1969), and in an earlier paper by him (Ashley, 1967). It is not our concern here to attempt a review of this field (the Royal College of Physicians' Report (1970) does that) but to look closely at some details of Ashley's paper. An unusual feature one notices is the use of a 'modified Standardized Mortality Ratio', calculated separately for each County Borough according to whether it formed part of a conurbation, and if not, whether its population was over 100,000 or 50,000-100,000. This is done on the grounds that since both lung cancer and bronchitis mortality are related to town size, a modification should be made before proceeding further. The implicit assumption is that something 'urban' is operating; and one wonders whether this same undefined 'urban' factor is producing a similar relationship of town size with mortality from suicide and from syphilis and an opposite one with mortality from accidental deaths (Registrar-General, 1967). A number of environmental factors, in particular air pollution and population density, are related to town size, and part of their association with mortality will be lost if the modified S.M.R.s are used. Three calculations are helpful. First, the mean S.M.R.s from lung cancer in males for County Boroughs in the three urban aggregates above are 121, 108 and 103 respectively (Registrar-General, 1967). Ashley's S.M.R.s have means of 99, 114 and 114, showing a gross distortion of the towns in the c urbations. Secondly, the correlation between population (Registrar-General, 1961) and the S.M.R. fro lung cancer in males (Registrar-General, 1967) for towns outside the conurbations is +0-31 hereas with Ashley's S.M.R. it is +0-22. This suggests that the procedure used has by no means eliminated the influence of town size, even if to do so were correct. Thirdly, the correlations between sulphur dioxide and the two S.M.R.s are +0-26 and -0-20 respectively; we have been unable to reproduce the published value of-0-23 for the latter coefficient from the data (Ashley, 1967). This reversal from a positive to a negative coefficient is due, we suggest, to the inappropriate modification. The Figure makes clear that, because of the association of town size and S02, towns low in SOa have had their S.M.R.s 'modified' upwards in general, and vice versa. There is little information in the papers of Ashley (1967,1969) on the way in which pollution data were sel cted from the tables published by the Depart ment of Scientific and Industrial Research (1963). Inspection shows that they represent values for the 58" @default.
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• W2049209736 title "Environmental factors in the aetiology of lung cancer and bronchitis." @default.
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• W2049209736 doi "https://doi.org/10.1136/jech.24.1.58" @default.
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