Table 14.
GRADE assessment – O3 peak exposure and respiratory mortality.
| Domain | Judgement | Down/Up Grade |
|---|---|---|
| Limitations in studies | 4 included studies. 1 study high risk of bias. Exclusion did not alter significantly the RR and CI (text). | No downgrading |
| Indirectness | All studies included the desired population, exposures and outcomes | No downgrading |
| Inconsistency | The 80% prediction interval included 1; PI = 2 × CI (Fig. 9). Substantial heterogeneity amongst small number of studies. | Downgrade one level |
| Imprecision | The number of person years in the included studies was greater than 940 000 | No downgrading |
| Publication Bias | No analysis of publication bias – too few studies (n = 3) | No downgrading |
| Large Effect Size | Summary RR = 1.02. Insufficient information on unmeasured potential confounders available | No upgrading |
| Plausible confounding towards null | Confounding direction unknown but precision may be affected. | No upgrading |
| Dose-response relation | A linear dose–response relationship was assumed in all studies. 95% CI for linear RR included 1. 1 study investigate the dose–response relationship. No evidence to confirm shape of the dose response relationship for Ozone exposure | No upgrading |
| GRADE conclusion | No downgrade and no upgrade | LOW CERTAINTY EVIDENCE MEAN RR UNADUSTED FOR CO-POLLUTANTS EQUALS 1.02 PER 10μ/m3 |