An evaluation of exposure metrics in an epidemiologic study on radio and television broadcast transmitters and the risk of childhood leukemia.

Electric field strength values calculated by wave propagation modeling were applied as an exposure metric in a case-control study conducted in Germany to investigate a possible association between radio frequency electromagnetic fields (RF-EMF) emitted from television and radio broadcast transmitters and the risk of childhood leukemia. To validate this approach it was examined at 850 measurement sites whether calculated RF-EMF are an improvement to an exposure proxy based on distance from the place of residence to a transmitter. Further, the agreement between measured and calculated RF-EMF was explored. For dichotomization at the 90% quantiles of the exposure distributions it was found that distance agreed less with measured RF-EMF (Kappa coefficient: 0.55) than did calculated RF-EMF (Kappa coefficient: 0.74). Distance was a good exposure proxy for a single transmitter only which uses the frequency bands of amplitude modulated radio, whereas it appeared to be of limited informative value in studies involving several transmitters, particularly if these are operating in different frequency bands. The analysis of the agreement between calculated RF-EMF and measured RF-EMF showed a sensitivity of 76.6% and a specificity of 97.4%, leading to an exposure misclassification that still allows one to detect a true odds ratio as low as 1.4 with a statistical power of >80% at a two-sided significance level of 5% in a study with 2,000 cases and 6,000 controls. Thus, calculated RF-EMF is confirmed to be an appropriate exposure metric in large-scale epidemiological studies on broadcast transmitters.