Periodic Reporting for period 3 - EPHOR (Exposome project for health and occupational research)
Reporting period: 2023-01-01 to 2024-06-30
Workplace exposure can lead to many diseases, such as cancer, cardiovascular and respiratory disease. It is estimated that 5-7% of global mortality is caused by workplace exposures. Given the large societal and economic impact, 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 co-occurring multiple occupational and environmental exposures during the working life and health.
The human exposome 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 will help address the current limitations by providing better insights into the relationships between a variety of exposures at work and disease at different life stages. Novel approaches and methods are needed to assess the working life exposome.
Our objective is to reduce the burden of occupationally related diseases by making available a working-life exposome toolbox containing:
• 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 for scientists, policy makers and occupational health practitioners.
The human exposome 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 will help address the current limitations by providing better insights into the relationships between a variety of exposures at work and disease at different life stages. Novel approaches and methods are needed to assess the working life exposome.
Our objective is to reduce the burden of occupationally related diseases by making available a working-life exposome toolbox containing:
• 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 for scientists, policy makers and occupational health practitioners.
Within EPHOR we combined two approaches 1) large-scale combination of existing data to investigate associations between multiple exposures and disease outcomes and 2) collection of new internal and external exposome data in two case studies.
Large scale combination of existing data
An inventory of relevant European cohorts has been made (>150), of which 29 cohorts are included to form the initial EPHOR mega cohort. Outcome working groups of studied diseases (cancer, cardiovascular/metabolic, neurodegenerative, musculoskeletal, mental, and respiratory) and work participation have reviewed the existing literature to define critical knowledge gaps (Ann Work Expo Health. 2024 Jul 8;68(6):562-580). This will help to set priorities in exposome-based occupational health research and has been a starting point for our data analyses plans. Data analyses in the cohorts will be performed in a meta analytical framework and is underway. Tools and methods developed to aid the data harmonisation and analyses (see https://www.we-expose.eu/tools-for-health-scientists#occupational_cohorts) include the cohort inventory, tools for automated and harmonised job coding, exposome data analyses methods, and EuroJEM. Exposome data analyses methods include: a) a tutorial of handling multiple exposures in exposure-response analyses b) an inventory of models for exposure time response analyses for estimating time dependent effects and c) several approaches to explore unknown exposure-disease associations. EuroJEM consists of harmonised existing job exposure matrices (JEMs) for respirable crystalline silica, nickel, wood dust, diesel engine exhaust, fast breathing due to heavy work, forward bent posture, heavy lifting, job demands, decision authority and noise and two newly developed JEMs for UV-light and precarious employment. New JEMs on respiratory infections and heat are under development. A protocol was developed to include new data in EuroJEM through text and data mining.
To enable health impact assessments making use of exposome data a review on the use of working life expectancy (WLE), healthy working life expectancy (HWLE) and working years lost (WYL) as outcomes has been performed, which has led to the development of tooling and guidance on the use of WLE. In addition simulation studies to investigate impact of a number of exposome concepts on health impact assessment has been finalised and are nearly completed. Tooling on WLE and the simulation study will be made available to policy makers via the WE-EXPOSE Toolbox. A stakeholder consultation to guide the development of these tools is underway.
Collection of new internal and external exposome data in two case studies.
Data collection has been completed for two case studies which investigate the effects of respiratory health in the general working population (147 subjects in a study on acute effects, 8600 subjects in a study on chronic effects) and general health in night shift workers (~900 subjects). For the collection of external exposome data, a wearable sensor system including environmental sensors, activity and heart rate monitor, was developed. Also, samplers for (s)VOCs and microbial diversity in dust and an ecological momentary assessment app were developed. For collection of the internal exposome, harmonised protocols were prepared including pre-processing and storage of blood, saliva, exhaled breath, exhaled breath aerosols and exhaled breath condensate. A pilot study has guided method development for the analyses of exposome markers in self-collected matrices. With respect to storage and interpretation of exposome data in the case studies, an existing data platform (YODA) has been customized for the EPHOR project.
Laboratory analyses have been initiated, and first statistical analyses have started. Lastly, a bioinformatics workflow for combining published bioinformatics data with adverse outcome pathways has been developed for allergic asthma and lung function decline. The methods for collection of exposome data and their interpretation are being made available to both health scientists and occupational safety and health (OSH) professionals via the WE-EXPOSE Toolbox . For the developments of specific tools stakeholders were consulted, and we adopted a co-creation process with OSH professionals which will result in guidance on how to correctly use low-cost sensors.
Large scale combination of existing data
An inventory of relevant European cohorts has been made (>150), of which 29 cohorts are included to form the initial EPHOR mega cohort. Outcome working groups of studied diseases (cancer, cardiovascular/metabolic, neurodegenerative, musculoskeletal, mental, and respiratory) and work participation have reviewed the existing literature to define critical knowledge gaps (Ann Work Expo Health. 2024 Jul 8;68(6):562-580). This will help to set priorities in exposome-based occupational health research and has been a starting point for our data analyses plans. Data analyses in the cohorts will be performed in a meta analytical framework and is underway. Tools and methods developed to aid the data harmonisation and analyses (see https://www.we-expose.eu/tools-for-health-scientists#occupational_cohorts) include the cohort inventory, tools for automated and harmonised job coding, exposome data analyses methods, and EuroJEM. Exposome data analyses methods include: a) a tutorial of handling multiple exposures in exposure-response analyses b) an inventory of models for exposure time response analyses for estimating time dependent effects and c) several approaches to explore unknown exposure-disease associations. EuroJEM consists of harmonised existing job exposure matrices (JEMs) for respirable crystalline silica, nickel, wood dust, diesel engine exhaust, fast breathing due to heavy work, forward bent posture, heavy lifting, job demands, decision authority and noise and two newly developed JEMs for UV-light and precarious employment. New JEMs on respiratory infections and heat are under development. A protocol was developed to include new data in EuroJEM through text and data mining.
To enable health impact assessments making use of exposome data a review on the use of working life expectancy (WLE), healthy working life expectancy (HWLE) and working years lost (WYL) as outcomes has been performed, which has led to the development of tooling and guidance on the use of WLE. In addition simulation studies to investigate impact of a number of exposome concepts on health impact assessment has been finalised and are nearly completed. Tooling on WLE and the simulation study will be made available to policy makers via the WE-EXPOSE Toolbox. A stakeholder consultation to guide the development of these tools is underway.
Collection of new internal and external exposome data in two case studies.
Data collection has been completed for two case studies which investigate the effects of respiratory health in the general working population (147 subjects in a study on acute effects, 8600 subjects in a study on chronic effects) and general health in night shift workers (~900 subjects). For the collection of external exposome data, a wearable sensor system including environmental sensors, activity and heart rate monitor, was developed. Also, samplers for (s)VOCs and microbial diversity in dust and an ecological momentary assessment app were developed. For collection of the internal exposome, harmonised protocols were prepared including pre-processing and storage of blood, saliva, exhaled breath, exhaled breath aerosols and exhaled breath condensate. A pilot study has guided method development for the analyses of exposome markers in self-collected matrices. With respect to storage and interpretation of exposome data in the case studies, an existing data platform (YODA) has been customized for the EPHOR project.
Laboratory analyses have been initiated, and first statistical analyses have started. Lastly, a bioinformatics workflow for combining published bioinformatics data with adverse outcome pathways has been developed for allergic asthma and lung function decline. The methods for collection of exposome data and their interpretation are being made available to both health scientists and occupational safety and health (OSH) professionals via the WE-EXPOSE Toolbox . For the developments of specific tools stakeholders were consulted, and we adopted a co-creation process with OSH professionals which will result in guidance on how to correctly use low-cost sensors.
The EPHOR project is the first large project that applies the exposome concept to lay a scientific foundation for improving working-life health related to multifactorial chronic disease, vulnerable life stages and complex exposure situations. The methods and concepts developed in EPHOR have already been taken up in various new projects and initiatives.
To aid the use of the methods and result of EPHOR beyond the project partners, 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 and productivity of the EU workforce, and increasing the competitiveness of EU industry.
The results of EPHOR are being communicated through: www.ephor-project.eu; www.we-expose.eu; www.humanexposome.eu and through https://www.linkedin.com/company/ephor-project-eu/.
To aid the use of the methods and result of EPHOR beyond the project partners, 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 and productivity of the EU workforce, and increasing the competitiveness of EU industry.
The results of EPHOR are being communicated through: www.ephor-project.eu; www.we-expose.eu; www.humanexposome.eu and through https://www.linkedin.com/company/ephor-project-eu/.