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Exposome project for health and occupational research

Periodic Reporting for period 1 - EPHOR (Exposome project for health and occupational research)

Reporting period: 2020-01-01 to 2021-06-30

Exposure in the workplace can lead to many diseases, such as cancer, cardiovascular and respiratory disease. The total burden of disease caused by occupational exposure is estimated at 5-7%. Given the associated societal and economic pressure, ensuring a healthy work environment is an important goal for society, government and industry. Current risk reduction policies and strategies are informed by existing scientific evidence, which is limited due to the challenges of studying the complex relationship between multiple exposures during the working life and health.

The exposome, which takes into account all relevant exposure throughout the course of life in relation to health, is a promising concept for elucidating the complex relationships between environment and disease. We define the working-life exposome as all occupational and related non-occupational exposures throughout the course of life. Taking a working-life exposome approach is a great step forward for occupational health science. It will help address the current limitations and challenges by providing better insights into the relationships between a variety of exposures at work and disease at different life stages. The working-life exposome is in its infancy and new approaches and methods are needed.

The EPHOR objective is to reduce the burden of occupationally related diseases by making a working-life exposome toolbox making available:
• Better and more complete knowledge on how multiple exposures within the working-life exposome are related to non-communicable diseases, including complex interactions of exposures, biological pathways and early signs of health damages, and vulnerability at different life-stages;
• Innovative methods for collection, storage, and interpretation of working-life exposome data, including its economic and societal impact: 1) Tools for scientists to expand the current knowledge base on the exposome in relation to health; 2) Tools for policy makers and occupational health practitioners to obtain data and information for developing evidence-based and cost-effective preventive actions and policies;
Within EPHOR we develop methods and tools to characterise the working-life exposome. By applying these, we will obtain better and more complete knowledge on the working-life exposome. We achieve this by 1) large-scale pooling of existing data to systematically investigate many types of exposure and diseases, looking at combinations of exposure, vulnerable groups and critical time windows, combined with 2) collection of new internal and external exposome data in two case studies.

At the time of reporting M18, an inventory of relevant European cohorts has been made (>140), of which 13 cohorts are included to form the initial EPHOR mega cohort which will be expanded later. Working groups around six groups of diseases (cancer, cardiovascular/metabolic, neurodegenerative, musculoskeletal, mental, and respiratory) are reviewing the existing literature to define critical knowledge gaps and research questions for analyses in the EPHOR mega cohort. In addition, protocols have been developed for two case studies which investigate the effects of working-life exposure on a) respiratory health in the general population and b) general health in night shift workers, by collecting extensive external exposure information with sensors, passive sampling and apps and internal markers of exposure and (early) disease. Obtaining ethics approvals for these studies is ongoing.

Method and technology developments to aid these exposome studies are ongoing. For standardised assessment of multiple exposures based on job title in large populations across Europe, the first steps towards a dynamic EuroJEM have been taken: an inventory and harmonisation of existing job exposure matrices (JEMs) for 1) chemical and particle, 2) ergonomic, 3) psychosocial and 4) physical work related exposures and development of new JEMs for occupational exposure to UV-light and precarious employment. For the new collection of external exposome data, a wearable sensor system, samplers for (s)VOCs (wearable) and microbial diversity in dust (stationary) and an ecological momentary assessment (EMA) questionnaire app were developed or adapted. These were combined in an external exposome protocol to be applied in the case studies, which is currently being tested in a feasibility study. A stakeholder consultation on acceptability, advantages and challenges of applying sensors among occupational health practitioners was accomplished. For collection of the internal exposome, harmonised protocols were prepared including pre-processing and storage of blood, urine, saliva, exhaled breath, exhaled breath aerosols and exhaled breath condensate. Due to the evolving COVID-19 situation, a literature review is ongoing to identify and optimise self-sampling methods that could be used as an alternative to traditional sampling methods. Methods for the analyses of exposome markers were adapted or are being developed. For the latter a pilot study is ongoing.

With respect to storage and interpretation of exposome data, an existing data platform (YODA) has been customized for the EPHOR project and tests for decentralised analyses through DataSHIELD have started. Methods development for analyses of exposome data is ongoing.

With respect to impact assessment methods, we have started to investigate the impact of using an exposure-response model that includes an exposure-decay function on the risk estimates and subsequently the burden of disease. Furthermore, we are considering the use of “working life expectancy” in the health impact assessment models and a protocol for health impact simulation studies is underway.

The name of the EPHOR toolbox is WE-EXPOSE. The online toolbox framework has been designed and developed and has been released for public access on This toolbox will be gradually extended over the course of the project. Currently already two concept tools are available: the searchable inventory of European occupational cohorts and an interactive protocol for biological sampling.
The EPHOR project is the first large project that applies the exposome concept in order to lay a scientific foundation for improving working-life health related to multifactorial chronic disease, vulnerable life stages and complex exposure situations. The following results are expected until the end of the project: 1) innovative methods for collection, storage, and use and interpretation of more complete and individual level working life exposome data; 2) better knowledge on how the working-life exposome relates to noncommunicable diseases (NCDs), including complex interactions, vulnerability, biological pathways and early signs of health damage, by uniquely combining large-scale pooling of existing cohorts with focused case studies; 3) models for assessing the economic and societal impact of working life exposures.

The WE-EXPOSE toolbox containing developed tools, methods and knowledge will be made available to scientists, policymakers and occupational health practitioners. By providing a knowledge base for evidence-based prevention, EPHOR will eventually contribute to reducing the burden of non-communicable diseases on EU healthcare systems, improving the health and wellbeing of EU citizens, improving the productivity of the EU workforce and increasing the competitiveness of EU industry.
Impact EPHOR project
Approach EPHOR project