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Saucy A, Coloma F, Olmos S, Åström C, Blay N, Boer JMA, Dadvand P, de Bont J, de Cid R, de Hoogh K, Dimakopoulou K, Gehring U, Huss A, Ibi D, Katsouyanni K, Koppelman G, Ljungman P, Melén E, Nieuwenhuijsen M, Nobile F, Peters A, Pickford R, Vermeulen R, Vienneau D, Vlaanderen J, Wolf K, Yu Z, Samoli E, Stafoggia M, Tonne C. Socioeconomic Inequalities in the External Exposome in European Cohorts: The EXPANSE Project. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024. [PMID: 39237108 DOI: 10.1021/acs.est.4c01509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Socioeconomic inequalities in the exposome have been found to be complex and highly context-specific, but studies have not been conducted in large population-wide cohorts from multiple countries. This study aims to examine the external exposome, encompassing individual and environmental factors influencing health over the life course, and to perform dimension reduction to derive interpretable characterization of the external exposome for multicountry epidemiological studies. Analyzing data from over 25 million individuals across seven European countries including 12 administrative and traditional cohorts, we utilized domain-specific principal component analysis (PCA) to define the external exposome, focusing on air pollution, the built environment, and air temperature. We conducted linear regression to estimate the association between individual- and area-level socioeconomic position and each domain of the external exposome. Consistent exposure patterns were observed within countries, indicating the representativeness of traditional cohorts for air pollution and the built environment. However, cohorts with limited geographical coverage and Southern European countries displayed lower temperature variability, especially in the cold season, compared to Northern European countries and cohorts including a wide range of urban and rural areas. The individual- and area-level socioeconomic determinants (i.e., education, income, and unemployment rate) of the urban exposome exhibited significant variability across the European region, with area-level indicators showing stronger associations than individual variables. While the PCA approach facilitated common interpretations of the external exposome for air pollution and the built environment, it was less effective for air temperature. The diverse socioeconomic determinants suggest regional variations in environmental health inequities, emphasizing the need for targeted interventions across European countries.
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Affiliation(s)
- Apolline Saucy
- ISGlobal, 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Fabián Coloma
- ISGlobal, 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Sergio Olmos
- ISGlobal, 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Christofer Åström
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
| | - Natalia Blay
- Genomes for Life-GCAT Lab, German Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Jolanda M A Boer
- National Institute for Public Health and the Environment, 3721 Bilthoven, The Netherlands
| | - Payam Dadvand
- ISGlobal, 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Jeroen de Bont
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Rafael de Cid
- Genomes for Life-GCAT Lab, German Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute Basel, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | - Konstantina Dimakopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 Utrecht, The Netherlands
| | - Anke Huss
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 Utrecht, The Netherlands
| | - Dorina Ibi
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 Utrecht, The Netherlands
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London W2 1PG, U.K
| | - Gerard Koppelman
- Department of Pediatric Pulmonology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD, University of Groningen, 9713 Groningen, The Netherlands
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Cardiology, Danderyd Hospital, 171 77 Stockholm, Sweden
| | - Erik Melén
- Department of Clinical Sciences and Education, Södersjukhuset, Karolinska Institutet, 171 77 Stockholm, Sweden
- Sachś Children and Youth Hospital, Södersjukhuset, 118 61 Stockholm, Sweden
| | - Mark Nieuwenhuijsen
- ISGlobal, 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Federica Nobile
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 100147 Rome, Italy
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
- IBE, Faculty of Medicine, Ludwig-Maximilians-Universität, 81377 Munich, Germany
| | - Regina Pickford
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Roel Vermeulen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 Utrecht, The Netherlands
| | - Danielle Vienneau
- Swiss Tropical and Public Health Institute Basel, 4123 Allschwil, Switzerland
- University of Basel, 4001 Basel, Switzerland
| | - Jelle Vlaanderen
- Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 Utrecht, The Netherlands
| | - Kathrin Wolf
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, 85764 Neuherberg, Germany
| | - Zhebin Yu
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Massimo Stafoggia
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Epidemiology, Lazio Region Health Service/ASL Roma 100147 Rome, Italy
| | - Cathryn Tonne
- ISGlobal, 08003 Barcelona, Spain
- Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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Pizzi C, Moirano G, Moccia C, Maule M, D'Errico A, Vrijheid M, Cadman TJ, Fossati S, Nieuwenhuijsen M, Beneito A, Calas L, Duijts L, Elhakeem A, Harris JR, Heude B, Jaddoe V, Lawlor DA, Lioret S, McEachan RR, Nader JL, Pedersen M, Pinot de Moira A, Strandberg-Larsen K, Subiza-Pérez M, Vafeiadi M, Welten M, Wright J, Yang TC, Richiardi L. Socioeconomic position during pregnancy and pre-school exposome in children from eight European birth cohort studies. Soc Sci Med 2024; 359:117275. [PMID: 39236481 DOI: 10.1016/j.socscimed.2024.117275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 08/04/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024]
Abstract
Distribution of environmental hazards and vulnerability to their effects vary across socioeconomic groups. Our objective was to analyse the relationship between child socioeconomic position (SEP) at birth and the external exposome at pre-school age (0-4 years). This study included more than 60,000 children from eight cohorts in eleven European cities (Oslo, Copenhagen, Bristol, Bradford, Rotterdam, Nancy, Poitiers, Gipuzkoa, Sabadell, Valencia and Turin). SEP was measured through maternal education and a standardised indicator of household income. Three child exposome domains were investigated: behavioral, diet and urban environment. We fitted separate logistic regression model for each exposome variable - dichotomised using the city-specific median - on SEP (medium/low vs high) adjusting for maternal age, country of birth and parity. Analyses were carried out separately in each study-area. Low-SEP children had, consistently across study-areas, lower Odds Ratios (ORs) of breastfeeding, consumption of eggs, fish, fruit, vegetables and higher ORs of TV screen time, pet ownership, exposure to second-hand smoke, consumption of dairy, potatoes, sweet beverages, savory biscuits and crisps, fats and carbohydrates. For example, maternal education-breastfeeding OR (95% Confidence Interval (CI)) ranged from 0.18 (0.14-0.24) in Bristol to 0.73 (0.58-0.90) in Oslo. SEP was also strongly associated with the urban environment with marked between-city heterogeneity. For example, income-PM2.5 OR (95%CI) ranged from 0.69 (0.47-1.02) in Sabadell to 2.44 (2.16-2.72) in Oslo. Already at pre-school age, children with lower SEP have consistently poorer diets and behaviours, which might influence their future health and wellbeing. SEP-urban environment relationships are strongly context-dependent.
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Affiliation(s)
- Costanza Pizzi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy.
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Chiara Moccia
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Antonio D'Errico
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Martine Vrijheid
- ISGlobal (Barcelona Institute for Global Health), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Timothy J Cadman
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Serena Fossati
- ISGlobal (Barcelona Institute for Global Health), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Mark Nieuwenhuijsen
- ISGlobal (Barcelona Institute for Global Health), Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Andrea Beneito
- Epidemiology and Environmental Health Joint Research Unit, University of Valencia, Valencia, Spain
| | - Lucinda Calas
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004, Paris, France
| | - Liesbeth Duijts
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ahmed Elhakeem
- MRC Integrative Epidemiology Unit, Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jennifer R Harris
- Center for Fertility and Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Barbara Heude
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004, Paris, France
| | - Vincent Jaddoe
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sandrine Lioret
- Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Center for Research in Epidemiology and StatisticS (CRESS), F-75004, Paris, France
| | - Rosemary Rc McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Johanna L Nader
- Department of Genetics and Bioinformatics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
| | - Marie Pedersen
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Angela Pinot de Moira
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Mikel Subiza-Pérez
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK; Department of Clinical and Health Psychology and Research Methods, University of the Basque Country UPV/EHU, Bilbao, Spain; Biogipuzkoa Health Research Institute, Environmental Epidemiology and Child Development Group, San Sebastian, Spain
| | - Marina Vafeiadi
- Department of Social Medicine, School of Medicine, University of Crete, Greece
| | - Marieke Welten
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Tiffany C Yang
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
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Lee DYX, Yau CE, Pek MPP, Xu H, Lim DYZ, Earnest A, Ong MEH, Ho AFW. Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study. Resusc Plus 2024; 18:100610. [PMID: 38524148 PMCID: PMC10960127 DOI: 10.1016/j.resplu.2024.100610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Background Socioeconomic status (SES) is a well-established determinant of cardiovascular health. However, the relationship between SES and clinical outcomes in long-term out-of-hospital cardiac arrest (OHCA) is less well-understood. The Singapore Housing Index (SHI) is a validated building-level SES indicator. We investigated whether SES as measured by SHI is associated with long-term OHCA survival in Singapore. Methods We conducted an open cohort study with linked data from the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS), and the Singapore Registry of Births and Deaths (SRBD) from 2010 to 2020. We fitted generalized structural equation models, calculating hazard ratios (HRs) using a Weibull model. We constructed Kaplan-Meier survival curves and calculated the predicted marginal probability for each SHI category. Results We included 659 cases. In both univariable and multivariable analyses, SHI did not have a significant association with survival. Indirect pathways of SHI mediated through covariates such as Emergency Medical Services (EMS) response time (HR of low-medium, high-medium and high SHI when compared to low SHI: 0.98 (0.88-1.10), 1.01 (0.93-1.11), 1.02 (0.93-1.12) respectively), and age of arrest (HR of low-medium, high-medium and high SHI when compared to low SHI: 1.02 (0.75-1.38), 1.08 (0.84-1.38), 1.18 (0.91-1.54) respectively) had no significant association with OHCA survival. There was no clear trend in the predicted marginal probability of survival among the different SHI categories. Conclusions We did not find a significant association between SES and OHCA survival outcomes in residential areas in Singapore. Among other reasons, this could be due to affordable healthcare across different socioeconomic classes.
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Affiliation(s)
- Dawn Yi Xin Lee
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Maeve Pin Pin Pek
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Hanzhang Xu
- Department of Family Medicine and Community Health, Duke University, North Carolina, USA
| | - Daniel Yan Zheng Lim
- Data Science and Artificial Intelligence Lab, Singapore General Hospital, Singapore, Singapore
- Department of Gastroenterology, Singapore General Hospital, Singapore, Singapore
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Pre-hospital and Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
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4
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Abellan A, Warembourg C, Mensink-Bout SM, Ambros A, de Castro M, Fossati S, Guxens M, Jaddoe VW, Nieuwenhuijsen MJ, Vrijheid M, Santos S, Casas M, Duijts L. Urban environment during pregnancy and lung function, wheezing, and asthma in school-age children. The generation R study. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2024; 344:123345. [PMID: 38219897 DOI: 10.1016/j.envpol.2024.123345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024]
Abstract
The urban environment during pregnancy may influence child's respiratory health, but scarce evidence exists on systematic evaluation of multiple urban exposures (e.g., air pollution, natural spaces, noise, built environment) on children's lung function, wheezing, and asthma development. We aimed to examine the association of the urban environment during pregnancy with lung function, preschool wheezing, and school-age asthma. We included 5624 mother-child pairs participating in a population-based prospective birth cohort. We estimated 30 urban environmental exposures including air pollution, road traffic noise, traffic, green spaces, blue spaces, and built environment during pregnancy. At 10 years of age, lung function was measured by spirometry. Information on preschool wheezing and physician-diagnosed school-age asthma was obtained from multiple questionnaires. We described single-exposure associations with respiratory outcomes using an exposome-wide association study. We also identified patterns of urban exposures with hierarchical clustering on principal components analysis and examined their associations with respiratory outcomes using multivariate regression models. Single-exposure analyses showed associations of higher particulate matter (PM) with lower mid-expiratory flow (FEF25-75%) (e.g., for PM < 2.5 μm of diameter [PM2.5] z-score = -0.06 [-0.09, -0.03]) and higher forced expiratory volume in 1s (FEV1) and forced vital capacity (FVC) (e.g., for PM2.5 FEV1 0.05 [0.02, 0.08]) after correction for multiple-hypothesis testing. Cluster analysis described three patterns of urban exposures during pregnancy and showed that the cluster characterised by higher levels of air pollution, noise, walkability, street connectivity, and lower levels of natural spaces were associated with lower FEF25-75% (-0.08 [-0.17, 0.00]), and higher odds of preschool wheezing (1.21 [1.03, 1.43]). This study shows that the characteristics of the urban environment during pregnancy are of relevance to the offspring's respiratory health during childhood.
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Affiliation(s)
- Alicia Abellan
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Charline Warembourg
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Sara M Mensink-Bout
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Albert Ambros
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Montserrat de Castro
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Serena Fossati
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Mònica Guxens
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain; Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Vincent Wv Jaddoe
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Mark J Nieuwenhuijsen
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Martine Vrijheid
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Susana Santos
- The Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Pediatrics, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Maribel Casas
- ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology, Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Division of Neonatology, Department of Neonatal and Pediatric Intensive Care, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
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5
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Lloyd D, House JS, Akhtari FS, Schmitt CP, Fargo DC, Scholl EH, Phillips J, Choksi S, Shah R, Hall JE, Motsinger-Reif AA. Questionnaire-based exposome-wide association studies for common diseases in the Personalized Environment and Genes Study. EXPOSOME 2024; 4:osae002. [PMID: 38450326 PMCID: PMC10914401 DOI: 10.1093/exposome/osae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/01/2024] [Indexed: 03/08/2024]
Abstract
The exposome collectively refers to all exposures, beginning in utero and continuing throughout life, and comprises not only standard environmental exposures such as point source pollution and ozone levels but also exposures from diet, medication, lifestyle factors, stress, and occupation. The exposome interacts with individual genetic and epigenetic characteristics to affect human health and disease, but large-scale studies that characterize the exposome and its relationships with human disease are limited. To address this gap, we used extensive questionnaire data from the diverse North Carolina-based Personalized Environment and Genes Study (PEGS, n = 9, 429) to evaluate exposure associations in relation to common diseases. We performed an exposome-wide association study (ExWAS) to examine single exposure models and their associations with 11 common complex diseases, namely allergic rhinitis, asthma, bone loss, fibroids, high cholesterol, hypertension, iron-deficient anemia, ovarian cysts, lower GI polyps, migraines, and type 2 diabetes. Across diseases, we found associations with lifestyle factors and socioeconomic status as well as asbestos, various dust types, biohazardous material, and textile-related exposures. We also found disease-specific associations such as fishing with lead weights and migraines. To differentiate between a replicated result and a novel finding, we used an AI-based literature search and database tool that allowed us to examine the current literature. We found both replicated findings, especially for lifestyle factors such as sleep and smoking across diseases, and novel findings, especially for occupational exposures and multiple diseases.
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Affiliation(s)
- Dillon Lloyd
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - John S House
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Farida S Akhtari
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Charles P Schmitt
- Division of Translational Toxicology, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - David C Fargo
- Office of the Director, National Institute of Environmental Health Sciences, Durham, NC, USA
| | | | | | | | | | - Janet E Hall
- Clinical Research Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
| | - Alison A Motsinger-Reif
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Durham, NC, USA
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6
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Gudi-Mindermann H, White M, Roczen J, Riedel N, Dreger S, Bolte G. Integrating the social environment with an equity perspective into the exposome paradigm: A new conceptual framework of the Social Exposome. ENVIRONMENTAL RESEARCH 2023; 233:116485. [PMID: 37352954 DOI: 10.1016/j.envres.2023.116485] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 06/25/2023]
Abstract
The importance of the social environment and social inequalities in disease etiology is well-known due to the profound research and conceptual framework on social determinants of health. For a long period, in exposome research with its classical orientation towards detrimental health effects of biological, chemical, and physical exposures, this knowledge remained underrepresented. But currently it gains great awareness and calls for innovations in rethinking the role of social environmental health determinants. To fill this gap that exists in terms of the social domain within exposome research, we propose a novel conceptual framework of the Social Exposome, to integrate the social environment in conjunction with the physical environment into the exposome concept. The iterative development process of the Social Exposome was based on a systematic compilation of social exposures in order to achieve a holistic portrayal of the human social environment - including social, psychosocial, socioeconomic, sociodemographic, local, regional, and cultural aspects, at individual and contextual levels. In order to move the Social Exposome beyond a mere compilation of exposures, three core principles are emphasized that underly the interplay of the multitude of exposures: Multidimensionality, Reciprocity, and Timing and continuity. The key focus of the conceptual framework of the Social Exposome is on understanding the underlying mechanisms that translate social exposures into health outcomes. In particular, insights from research on health equity and environmental justice have been incorporated to uncover how social inequalities in health emerge, are maintained, and systematically drive health outcomes. Three transmission pathways are presented: Embodiment, Resilience and Susceptibility or Vulnerability, and Empowerment. The Social Exposome conceptual framework may serve as a strategic map for, both, research and intervention planning, aiming to further explore the impact of the complex social environment and to alter transmission pathways to minimize health risks and health inequalities and to foster equity in health.
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Affiliation(s)
- Helene Gudi-Mindermann
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany.
| | - Maddie White
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Jana Roczen
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Natalie Riedel
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Stefanie Dreger
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
| | - Gabriele Bolte
- University of Bremen, Institute of Public Health and Nursing Research, Department of Social Epidemiology, Germany
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Cohen NJ, Yao M, Midya V, India-Aldana S, Mouzica T, Andra SS, Narasimhan S, Meher AK, Arora M, Chan JKY, Chan SY, Loy SL, Minguez-Alarcon L, Oulhote Y, Huang J, Valvi D. Exposure to perfluoroalkyl substances and women's fertility outcomes in a Singaporean population-based preconception cohort. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 873:162267. [PMID: 36801327 PMCID: PMC10234267 DOI: 10.1016/j.scitotenv.2023.162267] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Experimental models have demonstrated a link between exposure to perfluoroalkyl substances (PFAS) and decreased fertility and fecundability; however, human studies are scarce. We assessed the associations between preconception plasma PFAS concentrations and fertility outcomes in women. METHODS In a case-control study nested within the population-based Singapore Preconception Study of Long-Term Maternal and Child Outcomes (S-PRESTO), we measured PFAS in plasma collected in 2015-2017 from 382 women of reproductive age trying to conceive. Using Cox proportional hazards regression (fecundability ratios [FRs]) and logistic regression (odds ratios [ORs]) models, we assessed the associations of individual PFAS with time-to-pregnancy (TTP), and the likelihoods of clinical pregnancy and live birth, respectively, over one year of follow-up, adjusting for analytical batch, age, education, ethnicity, and parity. We used Bayesian weighted quantile sum (BWQS) regression to assess the associations of the PFAS mixture with fertility outcomes. RESULTS We found a 5-10 % reduction in fecundability per quartile increase of exposure to individual PFAS (FRs [95 % CIs] for clinical pregnancy = 0.90 [0.82, 0.98] for PFDA; 0.88 [0.79, 0.99] for PFOS; 0.95 [0.86, 1.06] for PFOA; 0.92 [0.84, 1.00] for PFHpA). We observed similar decreased odds of clinical pregnancy (ORs [95 % CIs] = 0.74 [0.56, 0.98] for PFDA; 0.76 [0.53, 1.09] for PFOS; 0.83 [0.59, 1.17] for PFOA; 0.92 [0.70, 1.22] for PFHpA) and live birth per quartile increases of individual PFAS and the PFAS mixture (ORs [95 % CIs] = 0.61 [0.37, 1.02] for clinical pregnancy, and 0.66 [0.40, 1.07] for live birth). Within the PFAS mixture, PFDA followed by PFOS, PFOA, and PFHpA were the biggest contributors to these associations. We found no evidence of association for PFHxS, PFNA, and PFHpS and the fertility outcomes examined. CONCLUSIONS Higher PFAS exposures may be associated with decreased fertility in women. The potential impact of ubiquitous PFAS exposures on infertility mechanisms requires further investigation.
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Affiliation(s)
- Nathan J Cohen
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America
| | - Meizhen Yao
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America
| | - Vishal Midya
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America
| | - Sandra India-Aldana
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America
| | - Tomer Mouzica
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America
| | - Syam S Andra
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America
| | - Srinivasan Narasimhan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America
| | - Anil K Meher
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America
| | - Manish Arora
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America
| | - Jerry Kok Yen Chan
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore; Academic Clinical Program in Obstetrics and Gynaecology, Duke-NUS Medical School, Singapore
| | - Shiao-Yng Chan
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology, and Research (A*STAR), Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - See Ling Loy
- Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore; Academic Clinical Program in Obstetrics and Gynaecology, Duke-NUS Medical School, Singapore
| | - Lidia Minguez-Alarcon
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, United States of America
| | - Youssef Oulhote
- Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts at Amherst, United States of America
| | - Jonathan Huang
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology, and Research (A*STAR), Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Damaskini Valvi
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, United States of America.
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Moccia C, Pizzi C, Moirano G, Popovic M, Zugna D, d'Errico A, Isaevska E, Fossati S, Nieuwenhuijsen MJ, Fariselli P, Sanavia T, Richiardi L, Maule M. Modelling socioeconomic position as a driver of the exposome in the first 18 months of life of the NINFEA birth cohort children. ENVIRONMENT INTERNATIONAL 2023; 173:107864. [PMID: 36913779 DOI: 10.1016/j.envint.2023.107864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The exposome drivers are less studied than its consequences but may be crucial in identifying population subgroups with unfavourable exposures. OBJECTIVES We used three approaches to study the socioeconomic position (SEP) as a driver of the early-life exposome in Turin children of the NINFEA cohort (Italy). METHODS Forty-two environmental exposures, collected at 18 months of age (N = 1989), were classified in 5 groups (lifestyle, diet, meteoclimatic, traffic-related, built environment). We performed cluster analysis to identify subjects sharing similar exposures, and intra-exposome-group Principal Component Analysis (PCA) to reduce the dimensionality. SEP at childbirth was measured through the Equivalised Household Income Indicator. SEP-exposome association was evaluated using: 1) an Exposome Wide Association Study (ExWAS), a one-exposure (SEP) one-outcome (exposome) approach; 2) multinomial regression of cluster membership on SEP; 3) regressions of each intra-exposome-group PC on SEP. RESULTS In the ExWAS, medium/low SEP children were more exposed to greenness, pet ownership, passive smoking, TV screen and sugar; less exposed to NO2, NOX, PM25abs, humidity, built environment, traffic load, unhealthy food facilities, fruit, vegetables, eggs, grain products, and childcare than high SEP children. Medium/low SEP children were more likely to belong to a cluster with poor diet, less air pollution, and to live in the suburbs than high SEP children. Medium/low SEP children were more exposed to lifestyle PC1 (unhealthy lifestyle) and diet PC2 (unhealthy diet), and less exposed to PC1s of the built environment (urbanization factors), diet (mixed diet), and traffic (air pollution) than high SEP children. CONCLUSIONS The three approaches provided consistent and complementary results, suggesting that children with lower SEP are less exposed to urbanization factors and more exposed to unhealthy lifestyles and diet. The simplest method, the ExWAS, conveys most of the information and is more replicable in other populations. Clustering and PCA may facilitate results interpretation and communication.
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Affiliation(s)
- Chiara Moccia
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy.
| | - Costanza Pizzi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Giovenale Moirano
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Maja Popovic
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Daniela Zugna
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Antonio d'Errico
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Elena Isaevska
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Serena Fossati
- ISGlobal (Barcelona Institute for Global Health), Barcelona, Spain
| | | | - Piero Fariselli
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Tiziana Sanavia
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Lorenzo Richiardi
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
| | - Milena Maule
- Cancer Epidemiology Unit, Department of Medical Sciences, University of Turin and CPO Piemonte, Turin, Italy
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