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Barrios-Rodríguez R, Garde C, Pérez-Carrascosa FM, Expósito J, Peinado FM, Fernández Rodríguez M, Requena P, Salcedo-Bellido I, Arrebola JP. Associations of accumulated persistent organic pollutants in breast adipose tissue with the evolution of breast cancer after surgery. Sci Total Environ 2023; 897:165373. [PMID: 37419338 DOI: 10.1016/j.scitotenv.2023.165373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/09/2023]
Abstract
Chronic exposure to persistent organic pollutants (POPs) is suspected to contribute to the onset of breast cancer, but the impact on the evolution of patients after diagnosis is unclear. We aimed to analyze the contribution of long-term exposure to five POPs to overall mortality, cancer recurrence, metastasis, and development of second primary tumors over a global follow-up of 10 years after surgery in breast cancer patients in a cohort study. Between 2012 and 2014, a total of 112 newly diagnosed breast cancer patients were recruited from a public hospital in Granada, Southern Spain. Historical exposure to POPs was estimated by analyzing their concentrations in breast adipose tissue samples. Sociodemographic data were collected through face-to-face interviews, while data on evolution tumor were retrieved from clinical records. Statistical analyses were performed using Cox regression (overall survival, breast cancer recurrence or metastasis) and binary logistic regression models (joint outcome variable). We also tested for statistical interactions of POPs with age, residence, and prognostic markers. The third vs first tertile of hexachlorobenzene concentrations was associated with a lower risk of all-cause mortality (Hazard Ratio, HR = 0.26; 95 % Confidence Interval, CI = 0.07-0.92) and of the appearance of any of the four events (Odds Ratio = 0.37; 95 % CI = 0.14-1.03). Polychlorinated biphenyl 138 concentrations were significantly and inversely associated with risk of metastasis (HR = 0.65; 95 % CI = 0.44-0.97) and tumor recurrence (HR = 0.69; 95 % CI = 0.49-0.98). Additionally, p,p'-dichlorodiphenyldichloroethylene showed inverse associations with risk of metastasis in women with ER-positive tumors (HR = 0.49; 95 % CI = 0.25-0.93) and in those with a tumor size <2.0 cm (HR = 0.39; 95 % CI = 0.18-0.87). The observed paradoxical inverse associations of POP exposure with breast cancer evolution might be related to either a better prognosis of hormone-dependent tumors, which have an approachable pharmacological target, or an effect of sequestration of circulating POPs by adipose tissue.
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Affiliation(s)
- R Barrios-Rodríguez
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - C Garde
- San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - F M Pérez-Carrascosa
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - J Expósito
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Virgen de las Nieves University Hospital, Radiation Oncology Department, Oncology Unit, Granada, Spain
| | - F M Peinado
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - M Fernández Rodríguez
- Universidad de Granada, Facultad de Farmacia, Departamento de Farmacia y Tecnología Farmacéutica, Granada, Spain
| | - P Requena
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - I Salcedo-Bellido
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
| | - J P Arrebola
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain.
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2
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Pérez-Carrascosa FM, Barrios-Rodríguez R, Gómez-Peña C, Salcedo-Bellido I, Velasco-García ME, Jiménez-Moleón JJ, García-Ruiz A, Navarro-Espigares JL, Requena P, Muñoz-Sánchez C, Arrebola JP. Public healthcare costs associated with long-term exposure to mixtures of persistent organic pollutants in two areas of Southern Spain: A longitudinal analysis. Environ Res 2022; 213:113609. [PMID: 35667403 DOI: 10.1016/j.envres.2022.113609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/24/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Polychlorinated biphenyls and organochlorine pesticides are persistent organic pollutants (POPs) that had been banned or restricted in many countries, including Spain. However, their ubiquity still poses environmental and human health threats. OBJECTIVE To longitudinally explore public healthcare costs associated with long-term exposure to a mixture of 8 POPs in a cohort of residents of two areas of Granada Province, Southern Spain. METHODS Longitudinal study in a subsample (n = 385) of GraMo adult cohort. Exposure assessment was performed by analyzing adipose tissue POP concentrations at recruitment. Average primary care (APC) and average hospital care (AHC) expenditures of each participant over 14 years were estimated using the data from their medical records. Data analyses were performed by robust MM regression, weighted quantile sum regression (WQS) and G-computation analysis. RESULTS In the adjusted robust MM models for APC, most POPs showed positive beta coefficients, being Hexachlorobenzene (HCB) significantly associated (β: 1.87; 95% Confidence interval (95%CI): 0.17, 3.57). The magnitude of this association increased (β: 3.72; 95%CI: 0.80, 6.64) when the analyses were restricted to semi-rural residents, where β-HCH was also marginally-significantly associated to APC (β: 3.40; 95%CI: -0.10, 6.90). WQS revealed a positive but non-significant mixture association with APC (β: 0.14; 95%CI: -0.06, 0.34), mainly accounted for by β-HCH (54%) and HCB (43%), that was borderline-significant in the semi-rural residents (β: 0.23; 95%CI: -0.01, 0.48). No significant results were observed in G-Computation analyses. CONCLUSION Long-term exposure to POP mixtures might represent a modifiable factor increasing healthcare costs, thus affecting the efficiency of the healthcare systems. However, and owing the complexity of the potential causal pathways and the limitations of the present study, further research is warranted to fully elucidate ascertain whether interventions to reduce human exposure should be considered in healthcare policies.
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Affiliation(s)
- Francisco Miguel Pérez-Carrascosa
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; Servicio de Oncología Radioterápica, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Rocío Barrios-Rodríguez
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Celia Gómez-Peña
- Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; Servicio de Farmacia Hospitalaria, Hospital Universitario San Cecilio, Granada, Spain
| | - Inmaculada Salcedo-Bellido
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - José Juan Jiménez-Moleón
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Antonio García-Ruiz
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Málaga, Spain; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - José Luis Navarro-Espigares
- Universidad de Granada, Departamento de Economía Internacional y de España, Granada, Spain; Dirección Económica y Servicios Generales, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Pilar Requena
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Carmen Muñoz-Sánchez
- Unidad de Tecnologías de La Información y Comunicaciones, Hospital Universitario San Cecilio, Granada, Spain
| | - Juan Pedro Arrebola
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria IBS.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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3
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Pérez-Carrascosa FM, Gómez-Peña C, Echeverría R, Jiménez Moleón JJ, Manuel Melchor J, García-Ruiz A, Navarro-Espigares JL, Cabeza-Barrera J, Martin-Olmedo P, Ortigosa-García JC, Arrebola JP. Historical exposure to persistent organic pollutants and cardiovascular disease: A 15-year longitudinal analysis focused on pharmaceutical consumption in primary care. Environ Int 2021; 156:106734. [PMID: 34224998 DOI: 10.1016/j.envint.2021.106734] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/26/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite restrictions on their production and use, most of the population is still exposed to Persistent Organic Pollutants (POPs), including organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs). These chemicals are thought to contribute to the aetiology of highly prevalent chronic conditions, such as cardiovascular diseases (CVDs), although current evidences are still controversial. OBJECTIVES To explore the potential contribution of historical POP exposure to 15-year pharmaceutical consumption in relation to CVD. METHODS This study is framed within GraMo adult cohort. Participants (n = 387) were recruited in two hospitals in Granada province, Southern Spain (2003-2004). Historical exposure to 5 OCPs and 3 non-dioxine-like PCBs was estimated by analysing adipose tissue concentrations at recruitment. Pharmaceutical consumption from recruitment until year 2017 was quantified by reviewing dispensation databases. Average consumption increase (ACI) in CVD medication was calculated by subtracting average consumption in 2002 to the average yearly consumption during follow-up. ACI was expressed as Defined Daily Dose (DDD)/year units. Data analyses were carried out using a multivariable multinomial logistic regression and weighted quantile sum regression (WQS), with ACI categorized in quartiles (Q) as the dependent variable. RESULTS Concentrations of most pollutants showed a positive trend with the quartiles of ACI. Particularly, PCB-153 showed increasing and statistically significant odds ratios (ORs) for Q2 (OR: 1.27, 95% confidence interval (CI): 1.07-1.52), Q3 (OR: 1.49, 95 %CI: 1.17-1.88) and Q4 (OR: 1.42, 95 %CI: 1.13-1.78) vs Q1. Similarly, beta-hexachlorocyclohexane (β-HCH) also showed increasing ORs, that reached statistical significance in Q4 (OR: 1.36, 95 %CI: 1.06-1.74) vs Q1. These findings were corroborated by WQS analyses, that revealed a significant mixture effect, predominantly accounted for by PCB-153 and β-HCH. DISCUSSION Our results suggest that long-term POP exposure might represent a modifiable risk factor for CVD. These findings are relevant for public health campaigns and management, since pharmaceutical consumption is considered an indicator of both morbidity and health expenditure.
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Affiliation(s)
- Francisco Miguel Pérez-Carrascosa
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Servicio de Oncología Radioterápica, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Celia Gómez-Peña
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Servicio de Farmacia Hospitalaria, Hospital Universitario San Cecilio, Granada, Spain.
| | - Ruth Echeverría
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain
| | - José Juan Jiménez Moleón
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Manuel Melchor
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Departamento de estadística e Investigación Operativa, Universidad de Granada, Granada, Spain; Unidad de Excelencia Modeling Nature, MNat, Universidad de Granada, Granada, Spain
| | - Antonio García-Ruiz
- Departamento de Farmacología y Pediatría, Universidad de Málaga, Málaga, Spain, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
| | - José Luis Navarro-Espigares
- Universidad de Granada, Departamento de Economía Internacional y de España, Granada, Spain; Dirección Económica y Servicios Generales, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - José Cabeza-Barrera
- Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; Servicio de Farmacia Hospitalaria, Hospital Universitario San Cecilio, Granada, Spain
| | | | - Juan Carlos Ortigosa-García
- Unidad de Tecnologías de la Información y Comunicaciones, Hospital Universitario San Cecilio, Granada, Spain
| | - Juan Pedro Arrebola
- Universidad de Granada, Departamento de Medicina Preventiva y Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
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4
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Arebola JP, Martin-Olmedo P, Pérez-Carrascosa FM, León J, Echeverría R, Salcedo-Bellido I, Gomez-Peña C. Integrated approaches for the assessment of health impacts of environmental chemicals: our experience in the GraMo cohort study. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
The assessment of the health implications of human exposure to low doses of multiple environmental chemical pollutants represents an important challenge for environmental epidemiology. Current studies must go beyond simple exposure-disease associations and need further characterization of a complete exposure disease continuum, including exposure routes, adverse outcome pathways, potential subclinical effects, interactions between chemicals, and intra-individual susceptibility. This needs an effective synergism with basic sciences, which can enrich epidemiologic findings with very detailed information at a molecular level, but also with clinicians, who would help to provide accurate diagnoses and interpretation in a real-world scenario.
On the other hand, environmental exposures can affect the general population at different levels, including economic and social dimensions, which have been frequently overlooked. These approaches would require specific methodologies that are relatively novel in the field of environmental epidemiology, such as cost-benefit analyses and qualitative techniques.
Public health campaigns can clearly benefit from these mixed approaches.
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Affiliation(s)
- J P Arebola
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
- University of Granada, Granada, Spain
| | - P Martin-Olmedo
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
- Escuela Andaluza de Salud Pública, Granada, Spain
| | - F M Pérez-Carrascosa
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
- University of Granada, Granada, Spain
| | - J León
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | | | - I Salcedo-Bellido
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
- University of Granada, Granada, Spain
| | - C Gomez-Peña
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
- University of Granada, Granada, Spain
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5
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Faris A, Expósito J, Martínez-Única A, Arrebola JP, Pérez-Carrascosa FM, Guerrero R, Tovar I. The efficacy of three-dimensional conformal radiation therapy on pain and quality of life in patients with painful bone metastases: a prospective study. Croat Med J 2020. [PMID: 32643337 PMCID: PMC7358686 DOI: 10.3325/cmj.2020.61.215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim Methods Results Conclusions
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6
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Colles A, Ardeleanu ER, Cendeias C, Ranzi A, Demeter Z, Hofer A, Kowalska M, Makris KC, Arrebola JP, Schoeters G, Hough R, Pérez-Carrascosa FM, Iavarone I, Martin-Olmedo P, Kalantzi OI, Ancona C, Ancona C, Pasetto R, Fletcher T, Hoek G, de Hoogh K. Human biomonitoring as a tool for exposure assessment in industrially contaminated sites (ICSs). Lessons learned within the ICS and Health European Network. Epidemiol Prev 2020; 43:249-259. [PMID: 31650780 DOI: 10.19191/ep19.4.a03.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND the mixed and complex nature of industrially contaminated sites (ICSs) leads to heterogeneity in exposure and health risk of residents living nearby. Health, environment, and social aspects are strongly interconnected in ICSs, and local communities are often concerned about potential health impact and needs for remediation. The use of human biomonitoring (HBM) for impact assessment of environmental exposure is increasing in Europe. The COST Action IS1408 on Industrially Contaminated Sites and Health Network (ICSHNet) decided to reflect on the potential and limitations of HBM to assess exposure and early health effects associated with living near ICSs. OBJECTIVES to discuss challenges and lessons learned for addressing environmental health impact near ICSs with HBM in order to identify needs and priorities for HBM guidelines in European ICSs. METHODS based on the experience of the ICSHNet research team, six case studies from different European regions that applied HBM at ICSs were selected. The case studies were systematically compared distinguishing four phases: the preparatory phase; study design; study results; the impact of the results at scientific, societal, and political levels. RESULTS all six case studies identified opportunities and challenges for applying HBM in ICS studies. A smart choice of (a combination of) sample matrices for biomarker analysis produced information about relevant time-windows of exposure which matched with the activities of the ICSs. Combining biomarkers of exposure with biomarkers of (early) biological effects, data from questionnaires or environmental data enabled fine-tuning of the results and allowed for more targeted remediating actions aimed to reduce exposure. Open and transparent communication of study results with contextual information and involvement of local stakeholders throughout the study helped to build confidence in the study results, gained support for remediating actions, and facilitated sharing of responsibilities. Using HBM in these ICS studies helped in setting priorities in policy actions and in further research. Limitations were the size of the study population, difficulties in recruiting vulnerable target populations, availability of validated biomarkers, and coping with exposure to mixtures of chemicals. CONCLUSIONS based on the identified positive experiences and challenges, the paper concludes with formulating recommendations for a European protocol and guidance document for HBM in ICS. This could advance the use of HBM in local environmental health policy development and evaluation of exposure levels, and promote coordination and collaboration between researchers and risk managers.
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Affiliation(s)
| | | | - Carla Cendeias
- EpiUnit, Public Health Institute, University of Porto (Portugal).,GeoBioTec, Geosciences Department, University of Aveiro, Santiago Campus, Aveiro (Portugal)
| | - Andrea Ranzi
- Center for Environmental Health and Prevention, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena (Italy)
| | | | - Adam Hofer
- National Public Health Institute (Hungary)
| | - Malgorzata Kowalska
- Department of Epidemiology, School of Medicine, Medical University of Silesia, Katowice (Poland)
| | - Konstantinos C Makris
- Water and Health Laboratory, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol (Cyprus)
| | - Juan Pedro Arrebola
- Department of Preventive Medicine and Public Health, University of Granada, Granada (Spain).,CIBER de Epidemiología y Salud Pública (CIBERESP), Spain.,Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada (Spain)
| | | | - Rupert Hough
- James Hutton Institute, Craigiebuckler, Aberdeen (UK)
| | | | - Ivano Iavarone
- Department of Environment and Health, Italian National Health Institute (ISS), Rome (Italy).,WHO Collaborating Centre for environmental health in contaminated sites, Rome (Italy)
| | - Piedad Martin-Olmedo
- Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Granada (Spain).,Escuela Andaluza de Salud Pública, Granada (Spain)
| | | | - Carla Ancona
- Epidemiology Department Lazio Regional Health Authority, Rome (Italy)
| | - Carla Ancona
- Epidemiology Department Lazio Regional Health Authority, Rome (Italy)
| | - Roberto Pasetto
- Department of Environment and Health, Italian National Health Institute (ISS), Rome (Italy).,WHO Collaborating Centre for environmental health in contaminated sites, Rome (Italy)
| | | | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht (The Netherlands)
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel (Switzerland).,University of Basel, Basel (Switzerland)
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7
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Hoek G, Ranzi A, Alimehmeti I, Ardeleanu ER, Arrebola JP, Ávila P, Candeias C, Colles A, Crișan GC, Dack S, Demeter Z, Fazzo L, Fierens T, Flückiger B, Gaengler S, Hänninen O, Harzia H, Hough R, Iantovics BL, Kalantzi OI, Karakitsios SP, Markis KC, Martin-Olmedo P, Nechita E, Nicoli T, Orru H, Pasetto R, Pérez-Carrascosa FM, Pestana D, Rocha F, Sarigiannis DA, Teixeira JP, Tsadilas C, Tasic V, Vaccari L, Iavarone I, de Hoogh K. A review of exposure assessment methods for epidemiological studies of health effects related to industrially contaminated sites. Epidemiol Prev 2019; 42:21-36. [PMID: 30322233 DOI: 10.19191/ep18.5-6.s1.p021.085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University (The Netherlands).
| | - Andrea Ranzi
- Environmental Health Reference Centre, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena (Italy)
| | - Ilir Alimehmeti
- Occupational Health Department, Faculty of Medicine, University of Medicine, Tirana (Albania)
| | | | - Juan P Arrebola
- Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), University of Granada (Spain).,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid (Spain).,Oncology Unit, Virgen de las Nieves University Hospital, Granada (Spain)
| | - Paula Ávila
- National Laboratory of Energy and Geology (LNEG), Amadora (Portugal)
| | - Carla Candeias
- EpiUnit, Public Health Institute, University of Porto (Portugal).,GeoBioTec, Geosciences Department, University of Aveiro, Santiago Campus (Portugal)
| | - Ann Colles
- Sustainable Health, Flemish Institute for Technological Research (VITO), Boeretang (Belgium)
| | | | - Sarah Dack
- Environmental Hazards and Emergencies Department, Centre for Radiation, Chemical and Environmental Hazards, Public Health England, London (UK)
| | | | - Lucia Fazzo
- Unit of Environmental and Social Epidemiology, Department of Environment and Health, Italian National Health Institute (ISS), Rome (Italy)
| | - Tine Fierens
- Sustainable Health, Flemish Institute for Technological Research (VITO), Boeretang (Belgium)
| | - Benjamin Flückiger
- Swiss Tropical and Public Health Institute, Basel (Switzerland).,University of Basel, Basel (Switzerland)
| | - Stephanie Gaengler
- Water and Health Laboratory, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limssol (Cyprus)
| | - Otto Hänninen
- Department Public Health Solutions, National Institute for Health and Welfare, Helsinki (Finland)
| | - Hedi Harzia
- Department of Environmental Health, Estonian Health Board, Tallinn (Estonia)
| | - Rupert Hough
- James Hutton Institute, Craigiebuckler, Aberdeen, Scotland (UK)
| | | | | | - Spyros P Karakitsios
- Department of Chemical Engineering, Environmental Engineering Laboratory, Aristotle University of Thessaloniki (Greece).,HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Thessaloniki (Greece)
| | - Konstantinos C Markis
- Water and Health Laboratory, Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limssol (Cyprus)
| | | | | | - Thomai Nicoli
- Hellenic Agricultural Organization, General Directorship of Agricultural Research, Institute of Industrial and Forage Crops, Larissa (Greece)
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu (Estonia)
| | - Roberto Pasetto
- Unit of Environmental and Social Epidemiology, Department of Environment and Health, Italian National Health Institute (ISS), Rome (Italy)
| | - Francisco Miguel Pérez-Carrascosa
- Instituto de Investigación Biosanitaria de Granada (ibs. GRANADA), University of Granada (Spain).,Oncology Unit, Virgen de las Nieves University Hospital, Granada (Spain)
| | - Diogo Pestana
- ICenter for Health Technology and Services Research (CINTESIS), Porto (Portugal).,Nutrition&Metabolism, NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa (Portugal)
| | - Fernando Rocha
- GeoBioTec, Geosciences Department, University of Aveiro, Santiago Campus (Portugal)
| | - Dimosthenis A Sarigiannis
- Department of Chemical Engineering, Environmental Engineering Laboratory, Aristotle University of Thessaloniki (Greece).,HERACLES Research Center on the Exposome and Health, Center for Interdisciplinary Research and Innovation, Balkan Center, Thessaloniki (Greece).,University School for Advanced Study (IUSS), Pavia (Italy)
| | | | - Christos Tsadilas
- Hellenic Agricultural Organization, General Directorship of Agricultural Research, Institute of Industrial and Forage Crops, Larissa (Greece)
| | - Visa Tasic
- Department for Industrial Informatics, Mining and Metallurgy Institute Bor (Serbia)
| | - Lorenzo Vaccari
- Environmental Health Reference Centre, Regional Agency for Prevention, Environment and Energy of Emilia-Romagna, Modena (Italy).,Department of Engineering "Enzo Ferrari", University of Modena and Reggio Emilia (Italy)
| | - Ivano Iavarone
- Unit of Environmental and Social Epidemiology, Department of Environment and Health, Italian National Health Institute (ISS), Rome (Italy)
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel (Switzerland).,University of Basel, Basel (Switzerland)
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