Letter: Robins-E risk of bias tool

Risk-of-bias tools are increasingly used as part of systematic reviews, to help make a uniform evaluation of study quality across a variety of studies (NASEM 2021). Several well-known tools, including OHAT and the Navigation Guide, are used to evaluate observational epidemiologic studies (OHAT 2019, Woodruff and Sutton, 2014). A recently published tool called ROBINS-E (Higgins et al. 2024) was developed to evaluate observational studies on environmental and occupational exposures. We have concerns regarding how this tool can be appropriately used and how it relates to other approaches to evidence synthesis. We are a group of environmental and occupational epidemiologists/exposure experts, nearly all of whom took part in the early discussion and piloting of this new risk-of-bias tool and previously published our general views on risk-of-bias tools (Steenland et al. 2020).