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(si apre in una nuova finestra)) 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.
