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Epidemiol Prev 2018; 42 (5-6): 21-36
DOI: https://doi.org/10.19191/EP18.5-6.S1.P021.085

A review of exposure assessment methods for epidemiological studies of health effects related to industrially contaminated sites

  • Gerard Hoek1

  • Andrea Ranzi2

  • Ilir Alimehmeti3

  • Elena-Roxana Ardeleanu4

  • Juan P. Arrebola5-7

  • Paula Ávila8

  • Carla Candeias9,10

  • Ann Colles11

  • Gloria Cerasela Crisan4

  • Sarah Dack12

  • Zoltán Demeter13

  • Lucia Fazzo14

  • Tine Fierens11

  • Benjamin Flückiger15,16

  • Stephanie Gaengler17

  • Otto Hänninen18

  • Hedi Harzia19

  • Rupert Hough20

  • Barna Laszlo Iantovics21

  • Olga-Ioanna Kalantzi22

  • Spyros P. Karakitsios23,24

  • Konstantinos C. Makris17

  • Piedad Martin-Olmedo25

  • Elena Nechita4

  • Thomai Nicoli26

  • Hans Orru27

  • Roberto Pasetto14

  • Francisco Miguel Pérez-Carrascosa5,7

  • Diogo Pestana28,29

  • Fernando Rocha10

  • Dimosthenis A. Sarigiannis23,24,30

  • João Paulo Teixeira9

  • Christos Tsadilas26

  • Visa Tasic31

  • Lorenzo Vaccari2,32

  • Ivano Iavarone14

  • Kees de Hoogh15,16

  1. Institute for Risk Assessment Sciences, Utrecht University (The Netherlands)
  2. Environmental Health Reference Centre, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena (Italy)
  3. Occupational Health Department, Faculty of Medicine, University of Medicine, Tirana (Albania)
  4. “Vasile Alecsandri” University of Bacău (Romania)
  5. Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), University of Granada (Spain)
  6. CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid (Spain)
  7. Oncology Unit, Virgen de las Nieves University Hospital, Granada (Spain)
  8. National Laboratory of Energy and Geology (LNEG), Amadora (Portugal)
  9. EpiUnit, Public Health Institute, University of Porto (Portugal)
  10. GeoBioTec, Geosciences Department, University of Aveiro, Santiago Campus (Portugal)
  11. Sustainable Health, Flemish Institute for Technological Research (VITO), Boeretang (Belgium)
  12. Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, London (UK)
  13. National Public Health Institute, Budapest (Hungary)
  14. Unit of Environmental and Social Epidemiology, Department of Environment and Health, Italian National Health Institute (ISS), Rome (Italy)
  15. Swiss Tropical and Public Health Institute, Basel (Switzerland)
  16. University of Basel, Basel (Switzerland)
  17. Water and Health Laboratory, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limssol (Cyprus)
  18. Department Public Health Solutions, National Institute for Health and Welfare, Helsinki (Finland)
  19. Department of Environmental Health, Estonian Health Board, Tallinn (Estonia)
  20. James Hutton Institute, Craigiebuckler, Aberdeen, Scotland (UK)
  21. “Petru Maior” University of Târgu Mureș (Romania)
  22. Department of Environment, University of the Aegean, Mytilene (Greece)
  23. Department of Chemical Engineering, Environmental Engineering Laboratory, Aristotle University of Thessaloniki (Greece)
  24. HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Thessaloniki (Greece)
  25. Escuela Andaluza de Salud Pública, Granada (Spain)
  26. Hellenic Agricultural Organization, General Directorship of Agricultural Research, Institute of Industrial and Forage Crops, Larissa (Greece)
  27. Institute of Family Medicine and Public Health, University of Tartu (Estonia)
  28. Center for Health Technology and Services Research (CINTESIS), Porto (Portugal)
  29. Nutrition&Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Portugal)
  30. University School for Advanced Study (IUSS), Pavia (Italy)
  31. Department for Industrial Informatics, Mining and Metallurgy Institute Bor (Serbia)
  32. Department of Engineering “Enzo Ferrari”, University of Modena and Reggio Emilia (Italy)
Gerard Hoek -

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BACKGROUND: this paper is based upon work from COST Action ICSHNet. Health risks related to living close to industrially contaminated sites (ICSs) are a public concern. Toxicology-based risk assessment of single contaminants is the main approach to assess health risks, but epidemiological studies which investigate the relationships between exposure and health directly in the affected population have contributed important evidence. Limitations in exposure assessment have substantially contributed to uncertainty about associations found in epidemiological studies.
OBJECTIVES:
to examine exposure assessment methods that have been used in epidemiological studies on ICSs and to provide recommendations for improved exposure assessment in epidemiological studies by comparing exposure assessment methods in epidemiological studies and risk assessments.
METHODS:
after defining the multi-media framework of exposure related to ICSs, we discussed selected multi-media models applied in Europe. We provided an overview of exposure assessment in 54 epidemiological studies from a systematic review of hazardous waste sites; a systematic review of 41 epidemiological studies on incinerators and 52 additional studies on ICSs and health identified for this review.
RESULTS:
we identified 10 multi-media models used in Europe primarily for risk assessment. Recent models incorporated estimation of internal biomarker levels. Predictions of the models differ particularly for the routes ‘indoor air inhalation’ and ‘vegetable consumption’. Virtually all of the 54 hazardous waste studies used proximity indicators of exposure, based on municipality or zip code of residence (28 studies) or distance to a contaminated site (25 studies). One study used human biomonitoring. In virtually all epidemiological studies, actual land use was ignored. In the 52 additional studies on contaminated sites, proximity indicators were applied in 39 studies, air pollution dispersion modelling in 6 studies, and human biomonitoring in 9 studies. Exposure assessment in epidemiological studies on incinerators included indicators (presence of source in municipality and distance to the incinerator) and air dispersion modelling. Environmental multi-media modelling methods were not applied in any of the three groups of studies.
CONCLUSIONS:
recommendations for refined exposure assessment in epidemiological studies included the use of more sophisticated exposure metrics instead of simple proximity indicators where feasible, as distance from a source results in misclassification of exposure as it ignores key determinants of environmental fate and transport, source characteristics, land use, and human consumption behaviour. More validation studies using personal exposure or human biomonitoring are needed to assess misclassification of exposure. Exposure assessment should take more advantage of the detailed multi-media exposure assessment procedures developed for risk assessment. The use of indicators can be substantially improved by linking definition of zones of exposure to existing knowledge of extent of dispersion. Studies should incorporate more often land use and individual behaviour.

Keywords: industrially contaminated sites, exposure assessment, dispersion modelling, biomonitoring, epidemiology

KEYPOINTS
What is already known

  • Health risks related to living close to industrially contaminated sites (ICSs) are a public concern.
  • Risk assessment of single contaminants is the main approach to assess health risks, but epidemiological studies have contributed important evidence.
  • Limitations in exposure assessment have substantially contributed to uncertainty about associations found in epidemiological studies.

 

What this paper adds

  • We conducted a review to examine exposure assessment methods used in epidemiological studies of ICSs in comparison with risk assessment.
  • The majority of studies used proximity indicators of exposure; air pollution dispersion modelling, soil monitoring, and human biomonitoring have been used in a small number of epidemiological studies.
  • Detailed multi-media environmental modelling methods, such as those used for regulatory risk assessment, were not applied.
  • Recommendations for refined exposure assessment in epidemiological studies were developed, including taking more advantage of the procedures developed for risk assessment, improvement of proximity indicators and the need for validation studies using personal exposure or human biomonitoring to assess misclassification of exposure.