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Table 2 Overview of indicator data on environmental exposure, health and data of human biomarkers that are available for environmental health research

From: Environmental health surveillance in a future European health information system

Indicators and/or relevant information within European programs Biomarkers POPs: dioxins furans, PCBs Metals: lead, arsenic, mercury cadmium Biocides: pesticides, herbicides fungicides Flame retardants: polybrominated/fluorinated diphenyl ethers, organochlorines, organophosphates Plasticizers/plastic compounds: (bis-) phenols, phthalates Coatings: perfluorinated compounds Personal care products: Polycyclic musks, disinfectants, trihalomethans, sunscreens Smoking: Cotinine and metabolites VOCs and VOCs: benzene, PAHs Acrylamide & metabolites Mycotoxins aflatoxin
HBM EXPOSURE BIOMARKERS
EXPOSURE ROUTE
Outdoor air
Emission of acidifying substances, O3, prim.PM, sec.PM (EEA), PM10(ENHIS)          x   
Exceedance of air quality limit values in urban areas (EEA)          x   
Particulate matter exposure PM10 (ECHI55)   x        x   
Indoor air
Indoor air (IPChem) x x   x x x   x x   x
Water
oxygen consuming substances (EEA) + nutrients in freshwater (EEA)    x         
contaminants in water (national databases)            
Soil (national databases) x x x       x   
Food
chemical contaminants: due to food production, distribution, packaging or consumption (EFSA) x x    x x    x x  
additives (EFSA)            
chemical residues: pesticides, hormones (EFSA)    x         
Consumer goods
Consumer goods direct contact, other than food (REACH1)     x x x x     
Industrial emissions
pollutant release to air, water and waste from ind. Facilities (EEA) x x x x      x   x
Waste
household consumption (EEA)   x x         
diversion waste from landfill (EEA)   x x       x   
Occupation            
work-related health risks (ECHI53) x x x x x x    x   x
HEALTH INDICATORS/INFORMATION
Smoking-related health outcomes
smoking-related deaths (ECHI15)         x    
regular smokers (ECHI44), pregnant women smoking (ECHI45)         x    
Cardiovascular outcomes
blood pressure (ECHI43)   x       x x   
Cancer
cancer incidence (ECHI20) x x x      x x x  
Diabetes
diabetes:self-reported+register-based prevalence (ECHI21A and B) x x x x x x x   x   
Fertility
Time to pregnancy (HBM) x x x x x x x     
total fertility rate (ECHI4) x x x x x x x     
Sexual maturation (HBM) x x x x x x x     
Immunologic outcomes
asthma, self-reported +register-based prevalence (ECHI26A and B) x x x x x x x x x x x
COPD, self-reported +register-based prevalence (ECHI27A and B) x x x x x x x x x x  
Allergies, allergic rhinitis, asthma, eczema, food allergy (HBM) x x x x x x x x x x x
Infections (respiratory and others) x x x x x x x x x x x
Neurologic outcomes
dementia/Alzheimer (ECHI22)   x x x x     x   
depression, self-reported +register-based prevalence (ECHI23A and B)   x x x x     x   
cognitive tests (HBM)   x x x x     x   
behaviour, autism, hyperactivity disorders (HBM)   x x x x     x   
growth and obesity, metabolic syndrome (HBM) x x x x x x x x x   
Fetal, neonatal, and child health
Spontaneous abortion/stillbirths/terminations (HBM) x x x x     x x   
Gestational age (HBM) x x x x     x x   
(low) birth weight (ECHI28) x x x x x    x x x  
mortality, birth weight, plurality (C1-C5) x x x x x    x x x  
Prevalence +deaths of selected congenital anomalies (R1, R3) x x x      x x x  
Distribution of Apgar score at 5 min (R2) x x x x x x x x x x  
Prevalence of cerebral palsy (R4)   x x       x   
Maternal health
Maternal mortality ratio (C6, C7)            
Incidence of severe maternal morbidity (R6) x x x x x x x x x x  
Mode of delivery (HBM) x           
Health in general
body mass index (ECHI42) X    x x x x X    
  1. Crosses in the table suggest which indicators/data can be linked in order to study either the human exposure route leading to measurable internal concentrations measured in humans (human biomarkers, in columns) and furthermore linking these biomarkers with health indicators/data (Note: EEA = Environmental Core Indicator; (ECHI = European Core Health indicators (ECHI nr); Health indicators of EUROPERISTAT (C = core, R = recommended); effect biomarkers of HBM studies/cohorts (HBM); IPCheM = Information Platform for Chemical Monitoring for inventarisation of indoor, HBM, food/feed and environmental data)