Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, 00271, Helsinki, Finland.
Department of Public Health and Welfare, Finnish Institute for Health and Welfare (THL), Mannerheimintie 166, 00271, Helsinki, Finland; Faculty of Sport and Health Sciences, University of Jyväskylä (JYU), Finland.
Int J Hyg Environ Health. 2023 Mar;248:114100. doi: 10.1016/j.ijheh.2022.114100. Epub 2022 Dec 9.
The European Human Biomonitoring Initiative (HBM4EU) is a joint program evaluating humans' exposure to several environmental substances and their potential health effects. One of the main objectives of HBM4EU is to make use of human biomonitoring (HBM) to assess human exposure to chemicals in Europe to better understand the associated health impacts and to improve chemical risk assessment. In parallel to HBM studies, health examination surveys (HESs), nutrition/dietary surveys, and disease specific health surveys are conducted in many European countries. In HESs, information collected by questionnaire(s) is supplemented with physical examinations and analysis of clinical and biological biomarkers in biological samples. HBM and health examination survey (HES) use similar data collection methods and infrastructures hence the feasibility of combining these two is explored in this paper.
Within HBM4EU, three feasibility studies (in Finland, Germany, and UK/England) were conducted to evaluate opportunities and obstacles of combining HBM and health studies. In this paper we report lessons learned from these feasibility studies.
The Finnish feasibility study called KouBio-KUOPIO study was a new initiative without links to existing studies. The German feasibility study added a HBM module to the first follow-up examination of the LIFE-Adult-Study, a population-based cohort study. The UK feasibility integrates a sustainable HBM module into the Health Survey for England (HSfE), an annual health examination survey. Benefits of combining HBM and HESs include the use of shared infrastructures. Furthermore, participants can receive additional health information from HES, and participation rates tend to be higher due to the potential to obtain personal health information. Preparatory phases including obtaining ethical approval can be time-consuming and complicated. Recruitment of participants and low participation rates are common concerns in survey research and therefore designing user-friendly questionnaires with low participant burden is important. Unexpected events such as the COVID-19 pandemic can cause substantial challenges and delays for such studies. Furthermore, experiences from several countries demonstrated that long-term funding for combined studies can be difficult to obtain.
In the future, incorporating HBM modules into existing HESs can provide a feasible and cost-effective method to conduct HBM studies and obtain a wide range of relevant data to support public health policies and research.
欧洲人类生物监测倡议（HBM4EU）是一个联合项目，旨在评估人类接触多种环境物质及其潜在健康影响。HBM4EU 的主要目标之一是利用人类生物监测（HBM）来评估欧洲人接触化学物质的情况，以更好地了解相关的健康影响，并改进化学风险评估。在进行 HBM 研究的同时，许多欧洲国家还开展了健康检查调查（HES）、营养/饮食调查和特定疾病健康调查。在 HES 中，通过问卷收集的信息通过体格检查和生物样本中临床和生物标志物的分析得到补充。HBM 和健康检查调查（HES）使用类似的数据收集方法和基础设施，因此本文探讨了将这两种方法结合起来的可行性。
在 HBM4EU 中，在芬兰、德国和英国/英格兰进行了三项可行性研究，以评估将 HBM 和健康研究相结合的机会和障碍。本文报告了这些可行性研究中获得的经验教训。
芬兰的可行性研究称为 KouBio-KUOPIO 研究，这是一项没有与现有研究联系的新倡议。德国的可行性研究在 LIFE-Adult-Study 的第一次随访检查中增加了 HBM 模块，该研究是一项基于人群的队列研究。英国的可行性研究将可持续的 HBM 模块整合到英格兰健康调查（HSfE）中，这是一项年度健康检查调查。将 HBM 和 HES 相结合的好处包括利用共享的基础设施。此外，参与者可以从 HES 获得更多的健康信息，并且由于有机会获得个人健康信息，参与率往往更高。包括获得伦理批准在内的筹备阶段可能既耗时又复杂。参与者的招募和低参与率是调查研究中的常见问题，因此设计具有用户友好型问卷和低参与者负担的问卷非常重要。像 COVID-19 大流行这样的意外事件会给这类研究带来巨大的挑战和延迟。此外，来自多个国家的经验表明，为联合研究提供长期资金可能很困难。
未来，将 HBM 模块纳入现有的 HES 可以提供一种可行且具有成本效益的方法来进行 HBM 研究，并获得广泛的相关数据，以支持公共卫生政策和研究。
