Epidemiol Prev 2018; 42 (5-6): 59-68

A scoping review of the epidemiological methods used to investigate the health effects of industrially contaminated sites

  • Manuela De Sario1

  • Roberto Pasetto2

  • Simona Vecchi1

  • Ariana Zeka3,4

  • Gerard Hoek5

  • Paola Michelozzi1

  • Ivano Iavarone2

  • Tony Fletcher6

  • Lisa Bauleo1

  • Carla Ancona1

  1. Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome (Italy)
  2. Department of Environment and Health, Italian National Institute of Health (ISS), Rome (Italy)
  3. Albanian National Institute of Public Health, Tirana (Albania)
  4. Department of Public Health, Albanian Medical University, Tirana (Albania)
  5. Institute for Risk Assessment Sciences, Utrecht University (The Netherlands)
  6. Public Health England, London (UK)
Lisa Bauleo -

(PDF; 2.1 MB)
(TableS2.xls; Table S4.xls)

BACKGROUND: this paper is based upon work from COST Action ICSHNet. Industrial contaminated sites (ICSs) are of high concern since industrial plants have produced widespread contamination potentially affecting the health of local population
OBJECTIVES: to assess the types of epidemiological designs applied in studies of health effects related to ICSs according to time periods, type of ICS, and geography.
a literature search was conducted in Medline (OVID) through June 30th, 2018, using MeSH and customized terms, and no restrictions on publication year or language. We included all studies throughout the world where a potential contamination of industrial origin occurred, an epidemiological approach (including biomonitoring, HBM) was applied, and health outcomes or exposure biomarkers among residents were investigated. Data on publication year, geographical localization and ICS characterization, study design (systematic reviews, cohort, case-control, temporal changes, cross-sectional, ecological, descriptive – area-level, case-series, narrative reviews, and HBM), and health outcomes were extracted from the abstracts. To check the sensitivity of the main search strategy, a case-study on Italy was conducted applying an ad-hoc search.
from a literature search capturing 5,485 studies, 655 studies on resident populations were identified. The review includes more than 376 different ICSs, 86% from Europe, North America, and Asia combined, mostly dealing with nuclear sites and mining industries, waste and petrochemical activities. Most of the studies were descriptive (32.5%), cross-sectional (16.3%), or narrative review (14.8%), while analytical studies – case-control and cohort studies (9.6% and 8.4%, respectively) – were rarer; HBM were only 6.9%. A total of 235 studies, conducted mostly in Asia (34.5%), Europe (25.5%), and North America (22.3%), included children. The most frequently studied outcome was cancer (33.7%), followed by respiratory diseases (11.4%), and reproductive health (11.4%). The ad-hoc strategy greatly increased the number of detected papers (+122%).§
CONCLUSIONS: future research should adopt the most valid and suitable study design, according to the area-specific social and environmental context, also in areas of the world which are less studied, but with very high environmental worries of the resident population suffering the industrial contamination. Involvement of local experts on ICSs and local inventories are recommended to improve the coverage of the present inventory.

Keywords: environmental epidemiology, industrially contaminated sites, residential exposure, study design


What is already known

  • Industrially contaminated sites (ICSs) involving a variety of hazardous agents are found in almost all Countries of the world, as pollutants are intentionally or accidentally released into the environment.
  • For the purpose of identifying studies referred to contaminated sites, there is the need to have a standard definition of the term ‘contaminated site’ or the adoption of common keywords related to ‘contaminated sites’, not available at the moment.
  • Different approaches in environmental epidemiology have been used to study the health effects of ICSs on the local communities.


What this paper adds

  • The present extensive literature search provided an inventory of 762 publications summarizing the effect of 376 different ICSs, with higher quality study designs increasing over time.
  • To improve the sensitivity of search strategies, a collaboration with local experts is needed to identify local ICS names and inventories.