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- Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortalityPublication . Huang, Wenzhong; Li, Tiantian; Masselot, Pierre; Xu, Rongbin; Gasparrini, Antonio; Sera, Francesco; Bell, Michelle L.; Hashizume, Masahiro; Breitner, Susanne; Tong, Shilu; Kan, Haidong; Yang, Zhengyu; Zhang, Yiwen; Yu, Wenhua; Yu, Pei; Zhou, Shuang; Sun, Qinghua; Zhang, Jingwei; Lavigne, Eric; Madureira, Joana; Guo, Yue Leon; Gaio, Vânia; Li, Shanshan; Guo, Yuming; MCC Collaborative Research NetworkAmbient air pollutants are leading contributors to global mortality. Despite the well-established risks, most studies have relied on single-pollutant models in limited regions, leaving the combined effects and individual contributions of pollutants unclear, particularly across countries. Here, we integrate daily mortality and air pollutant (nitrogen dioxide [NO], ozone [O], fine particulate matter, and sulfur dioxide) data from 482 cities in 12 countries/territories from 1998 to 2021 to assess the joint mortality risks and identify the main contributing pollutant through an air quality health index of multi-pollutant constrained groupwise additive models (AQHI-Multi). AQHI-Multi outperformed commonly used air quality indices in capturing the overall mortality risks. O and NO were the leading contributors (accounting for over 70% across countries/territories), with O's share increasing slightly to moderately in most countries/territories. These findings highlight the need for developing air quality indices using advanced multi-pollutant models and the emerging global significance of targeted control of O and NO.
- Global excess deaths associated with heatwaves in 2023 and the contribution of human-induced climate changePublication . Hundessa, Samuel; Huang, Wenzhong; Xu, Rongbin; Yang, Zhengyu; Zhao, Qi; Gasparrini, Antonio; Armstrong, Ben; Bell, Michelle L.; Huber, Veronika; Urban, Aleš; Coelho, Micheline; Sera, Francesco; Tong, Shilu; Royé, Dominic; Kyselý, Jan; de'Donato, Francesca; Mistry, Malcolm; Tobias, Aurelio; Íñiguez, Carmen; Ragettli, Martina S.; Hales, Simon; Achilleos, Souzana; Klompmaker, Jochem; Li, Shanshan; Guo, Yuming; Multi-Country Multi-City Collaborative Research NetworkAbstract: An unprecedented heatwave swept the globe in 2023, marking it one of the hottest years on record and raising concerns about its health impacts. However, a comprehensive assessment of the heatwave-related mortality and its attribution to human-induced climate change remains lacking. We aim to address this gap by analyzing high-resolution climate and mortality data from 2,013 locations across 67 countries/territories using a three-stage modeling approach. First, we estimated historical heatwave-mortality associations using a quasi-Poisson regression model with distributed lag structures, considering lag effects, seasonality, and within-week variations. Second, we pooled the estimates in meta-regression, accounting for spatial heterogeneity and potential changes in heatwave-mortality associations over time. Third, we predicted grid-specific (0.5 0.5) association in 2023 and calculated the heatwave-related excess deaths, death ratio, and death rate per million people. Attribution analysis was conducted by comparing heatwave-related mortality under factual and counterfactual climate scenarios. We estimated 178,486 excess deaths (95% empirical confidence interval [eCI], 159,892≥204,147) related to the 2023 heatwave, accounting for 0.73% of global deaths, corresponding to 23 deaths per million people. The highest mortality rates occurred in Southern (120, 95% eCI, 116≥126), Eastern (107, 95% eCI, 100≥114), and Western Europe (66, 95% eCI, 62≥70), where the excess death ratio was also higher. Notably, 54.29% (95% eCI, 45.71%≥61.36%) of the global heatwave-related deaths were attributable to human-induced climate change. These results underscore the urgent need for adaptive public health interventions and climate mitigation strategies to reduce future mortality burdens in the context of increasing global warming.
- Short-term association between hot nights and mortality: a multicountry analysis in 178 locations considering hourly ambient temperaturePublication . Royé, Dominic; Sera, Francesco; Tobías, Aurelio; Hashizume, Masahiro; Honda, Yasushi; Kim, Ho; Vicedo-Cabrera, Ana Maria; Tong, Shilu; Lavigne, Eric; Kyselý, Jan; Pascal, Mathilde; de'Donato, Francesca; das Neves Pereira da Silva, Susana; Madureira, Joana; Huber, Veronika; Urban, Aleš; Schwartz, Joel; Bell, Michelle L.; Armstrong, Ben; Iñiguez, Carmen; MCC Collaborative Research NetworkBackground: The rise in hot nights over recent decades and projections of further increases due to climate change underscores the critical need to understand their impact. This knowledge is essential for shaping public health strategies and guiding adaptation efforts. Despite their significance, research on the implications of hot nights remains limited. Objective: This study estimated the association between hot-night excess (the sum of excess heat during the nighttime above a threshold) and duration (the percent of nighttime with a positive excess) based on hourly ambient temperatures and daily mortality in the warm season over multiple locations worldwide. Methods: We fitted time series regression models to mortality in 178 locations across 44 countries using a distributed lag non-linear model over lags of 0-3 days, controlling for daily maximum temperature and daily mean absolute humidity. Next, we used a multivariate meta-regression model to pool results and estimated attributable burdens. Results: We found a positive, increasing mortality risk with hot-night excess and duration. Assuming 0 as a reference, the pooled relative risks of death associated with extreme excess and duration, defined as the 90th percentile in each index, were both similar at 1.026 (95 % CI, 1.017; 1.036) and 1.026 (95 % CI, 1.013; 1.040). The overall estimated attributable fractions were also observed to be closely similar at 0.60 % (95 % CI, 0.09; 1.10 %) and 0.62 % (95 % CI, 0.00; 1.23 %), respectively. Discussion: This study provides new evidence that hot nights have a specific contribution to heat-related mortality risk. Modeling thermal characteristics' sub-hourly impact on mortality during the night could improve decision-making for long-term adaptions and preventive public health strategies.
- Estimating the urban heat-related mortality burden due to greenness: a global modelling studyPublication . Wu, Yao; Wen, Bo; Ye, Tingting; Huang, Wenzhong; Liu, Yanming; Gasparrini, Antonio; Sera, Francesco; Tong, Shilu; Lavigne, Eric; Roye, Dominic; Achilleos, Souzana; Ryti, Niilo; Pascal, Mathilde; Zeka, Ariana; de'Donato, Francesca; das Neves Pereira da Silva, Susana; Madureira, Joana; Mistry, Malcolm; Armstrong, Ben; Bell, Michelle L; Schwartz, Joel; Guo, Yuming; Li, ShanshanBackground: Heat exposure poses a substantial public health threat. Increasing greenness has been suggested as a mitigation strategy due to its cooling effect and potential to modify the heat-mortality association. This study aimed to comprehensively estimate the effects of increased greenness on heat-related deaths. Methods: We applied a multistage meta-analytical approach to estimate the potential reduction in global heat-related deaths by increasing greenness in the warm season in 2000-19 in 11 534 urban areas. We used the enhanced vegetation index (EVI) to indicate greenness and a random forest model to predict daily temperatures in counterfactual EVI scenarios. In the factual EVI scenarios, daily mortality and weather variables from 830 locations in 53 countries were extracted from the Multi-Country Multi-City Collaborative Research Network and used to assess heat-mortality associations. These associations were then extrapolated to each urban area under both factual and counterfactual EVI scenarios based on meta-regression models. Findings: We estimated that EVI increased by 10% would decrease the global population-weighted warm-season mean temperature by 0·08°C, EVI increased by 20% would decrease temperature by 0·14°C, and EVI increased by 30% would decrease temperature by 0·19°C. In the factual scenario, 3 153 225 (2·48%) of 127 179 341 total deaths could be attributed to heat exposure. The attributable fraction of heat-related deaths (as a fraction of total deaths) in 2000-19 would decrease by 0·67 (95% empirical CI 0·53-0·82) percentage points in the 10% scenario, 0·80 (0·63-0·97) percentage points in the 20% scenario, and 0·91 (0·72-1·10) percentage points in the 30% scenario, compared with the factual scenario. South Europe was modelled to have the largest decrease in attributable fraction of heat-related mortality. Interpretation: This modelling study suggests that increased greenness could substantially reduce the heat-related mortality burden. Preserving and expanding greenness might be potential strategies to lower ambient temperature and reduce the health impacts of heat exposure.
- Associations of ambient exposure to benzene, toluene, ethylbenzene, and xylene with daily mortality: a multicountry time-series study in 757 global locationsPublication . Zhou, Lu; Xiong, Ying; Sera, Francesco; Vicedo-Cabrera, Ana Maria; Abrutzky, Rosana; Guo, Yuming; Tong, Shilu; Coelho, Micheline de Sousa Zanotti Stagliorio; Saldiva, Paulo Hilario Nascimento; Lavigne, Eric; Correa, Patricia Matus; Ortega, Nicolás Valdés; Osorio, Samuel; Roye, Dominic; Kyselý, Jan; Orru, Hans; Maasikmets, Marek; Jaakkola, Jouni J.K.; Ryti, Niilo; Pascal, Mathilde; Huber, Veronika; Breitner-Busch, Susanne; Schneider, Alexandra; Katsouyanni, Klea; Samoli, Evangelia; Entezari, Alireza; Mayvaneh, Fatemeh; Goodman, Patrick; Zeka, Ariana; Raz, Raanan; Scortichini, Matteo; Stafoggia, Massimo; Honda, Yasushi; Hashizume, Masahiro; Ng, Chris Fook Sheng; Alahmad, Barrak; Diaz, Magali Hurtado; Félix Arellano, Eunice Elizabeth; Overcenco, Ala; Klompmaker, Jochem; Rao, Shilpa; Carrasco, Gabriel; Seposo, Xerxes; Chua, Paul Lester Carlos; das Neves Pereira da Silva, Susana; Madureira, Joana; Holobaca, Iulian-Horia; Scovronick, Noah; Garland, Rebecca M.; Kim, Ho; Lee, Whanhee; Tobias, Aurelio; Íñiguez, Carmen; Forsberg, Bertil; Ragettli, Martina S.; Guo, Yue Leon; Pan, Shih-Chun; Li, Shanshan; Masselot, Pierre; Colistro, Valentina; Bell, Michelle; Zanobetti, Antonella; Schwartz, Joel; Dang, Tran Ngoc; Van Dung, Do; Gasparrini, Antonio; Huang, Yaoxian; Kan, HaidongBackground: The presence of benzene, toluene, ethylbenzene, and xylene isomers (BTEX) in the environment is of increasing concern due to their toxicity and ubiquity. Although the adverse health effects of BTEX exposure have been documented, robust epidemiological evidence from large-scale, multicountry studies using advanced exposure assessment methodologies remains scarce. We aimed to assess the association of short-term ambient exposure to individual BTEX components and their mixture with daily total, cardiovascular, and respiratory mortality on a global scale. Methods: Daily data on mortality, meteorological factors, and air pollution were collected from 757 locations across 46 countries or regions. Data on individual chemicals (ie, benzene, toluene, xylenes [summation of ethylbenzene, m-xylene, p-xylene, and o-xylene]) and the aggregate mixture (ie, BTEX) were estimated using a chemistry–climate model. We examined the short-term associations of each individual chemical as well as the BTEX mixture with daily total, cardiovascular, and respiratory mortality in a multicountry framework. Using a two-stage time-series design, we first applied generalised additive models with a quasi-Poisson distribution to obtain location-specific associations, which were subsequently pooled using random-effects meta-analysis. Two-pollutant models were used to assess the independent effects of BTEX after adjusting for co-pollutants (PM2·5, PM10, nitrogen dioxide, sulphur dioxide, ozone, and carbon monoxide). Additionally, we assessed the overall exposure–response curves with spline terms. Findings: An IQR increment of BTEX concentration on lag 0–2 days (3-day moving average of the present day and the previous 2 days) was associated with increases of 0·57% (95% CI 0·49–0·65), 0·42% (0·30–0·54), and 0·68% (0·50–0·86) in total, cardiovascular, and respiratory mortality, respectively. The corresponding effect estimates for an IQR increment in individual chemicals (benzene, toluene, and xylenes) were 0·38–0·61%, 0·44–0·70%, and 0·41–0·65%, respectively. The associations remained significant after adjusting for co-pollutants, with a general decline in magnitude, except for a slight increase after adjustment for ozone. The shape of the exposure–response curves for all pollutants and causes of death was almost linear, with steeper slopes at low concentrations and no discernible thresholds. Interpretation: This global study provides novel evidence linking short-term exposure to ambient BTEX, both individually and as a mixture, with increased daily total, cardiovascular, and respiratory mortality. Our findings underscore the need for comprehensive air pollution mitigation policies, including stringent controls on BTEX emissions, to protect public health.
- FAIREHR: a novel online research registry platform to advance global environmental and occupational health researchPublication . Galea, Karen S.; Brooker, Finlay; Rashid, Shahzad; Bader, Michael; Ait Bamai, Yu; Bessems, Jos; Beyene, Embialle Mengistie; Connolly, Alison; Costa, Carla; Deligannu, Pravina; Duca, Radu-Corneliu; Chbihi, Kaoutar; Eba, Kasahun; Ghosh, Manosij; Gonzales, Melissa; Harrad, Stuart; Haynes, Erin N.; Hopf, Nancy B.; Huang, Po-Chin; Jones, Kate; Kasiotis, Konstantinos M.; Chung, Ming Kei; Kil, Jihyon; Koch, Holger; Kwon, Jung-Hwan; Lin, Elizabeth Ziying; Louro, Henriqueta; Machera, Kyriaki; Magagna, Barbara; Menouni, Aziza; Mizuno, Yuki; Van Nieuwenhuyse, An; Nakayama, Shoji F.; Robert Pasanen-Kase; Pollock, Tyler; Quirós-Alcalá, Lesliam; Santonen, Tiina; Scheepers, Paul J.; Sepai, Ovnair; Bird, Emily; Serrano Ramòn, Blanca; Silva, Maria Joao; Souza, Gustavo; Stingone, Jeanette A.; Teitelbaum, L. Susan; Teixeira, João Paulo; Tranfo, Giovanna; Vekic, Ana Maria; Viegas, Susana; Xia, Yankai; Yunesian, Masud; Zare Jeddi, MaryamThe FAIREHR (Findable, Accessible, Interoperable, Reusable Environmental and Health Registry) platform is a state-of-the-art online registry for prospective harmonization of human biomonitoring (HBM). It was developed by the HBM working group of the Europe Regional Chapter of the International Society of Exposure Science (ISES Europe) and is supported by the HBM Global Network. FAIREHR is designed to harmonize HBM metadata and support the implementation of the FAIR (Findable, Accessible, Interoperable and Reusable) Guiding Principles throughout HBM studies or programs. The registry enables preregistration of HBM by capturing key metadata on study design, metadata management, and planned methods before participant recruitment. This process enhances transparency and reproducibility in environmental and occupational health research. FAIREHR includes both study-level and program-level metadata. Its harmonized metadata template facilitates the storage of results (measurement data) in repositories such as IPCHEM and PEH. Here we outline the unique features of the FAIREHR platform, emphasizing its role in increasing research visibility, improving metadata comparability and harmonization, and strengthening the exchange of information. By supporting the effective use of HBM data, FAIREHR is expected to yield significant benefits for researchers, policymakers, and the broader fields of environmental and occupational health.
- Hazard characterization of the mycotoxins enniatins and beauvericin to identify data gaps and improve risk assessment for human healthPublication . Behr, Anne-Cathrin; Fæste, Christiane Kruse; Azqueta, Amaya; Tavares, Ana M.; Spyropoulou, Anastasia; Solhaug, Anita; Olsen, Ann-Karin; Vettorazzi, Ariane; Mertens, Birgit; Zegura, Bojana; Streel, Camille; Ndiaye, Dieynaba; Spilioti, Eliana; Dubreil, Estelle; Buratti, Franca Maria; Crudo, Francesco; Eriksen, Gunnar Sundstøl; Snapkow, Igor; Teixeira, João Paulo; Rasinger, Josef D.; Sanders, Julie; Machera, Kyriaki; Ivanova, Lada; Gaté, Laurent; Le Hegarat, Ludovic; Novak, Matjaz; Smith, Nicola M.; Tait, Sabrina; Fraga, Sónia; Hager, Sonja; Marko, Doris; Braeuning, Albert; Louro, Henriqueta; Silva, Maria João; Dirven, Hubert; Dietrich, JessicaEnniatins (ENNs) and beauvericin (BEA) are cyclic hexadepsipeptide fungal metabolites which have demonstrated antibiotic, antimycotic, and insecticidal activities. The substantial toxic potentials of these mycotoxins are associated with their ionophoric molecular properties and relatively high lipophilicities. ENNs occur extensively in grain and grain-derived products and are considered a food safety issue by the European Food Safety Authority (EFSA). The tolerable daily intake and maximum levels for ENNs in humans and animals remain unestablished due to key toxicological and toxicokinetic data gaps, preventing full risk assessment. Aiming to find critical data gaps impeding hazard characterization and risk evaluation, this review presents a comprehensive summary of the existing information from in vitro and in vivo studies on toxicokinetic characteristics and cytotoxic, genotoxic, immunotoxic, endocrine, reproductive and developmental effects of the most prevalent ENN analogues (ENN A, A1, B, B1) and BEA. The missing information identified showed that additional studies on ENNs and BEA have to be performed before sufficient data for an in-depth hazard characterisation of these mycotoxins become available.
- HBM4EU E-waste study – An untargeted metabolomics approach to characterize metabolic changes during E-waste recyclingPublication . Kozlowska, Lucyna; Viegas, Susana; Scheepers, Paul T.J.; Duca, Radu C.; Godderis, Lode; Martins, Carla; Krzesimir, Ciura; Jagiello, Karolina; Silva, Maria João; Mahiout, Selma; Mārtiņsone, Inese; Matisāne, Linda; van Nieuwenhuyse, An; Puzyn, Tomasz; Sijko-Szpanska, Monika; Verdonck, Jelle; Santonen, Tiina; HBM4EU E-waste Study TeamE-waste contains hazardous chemicals that may be a direct health risk for workers involved in recycling. We conducted an untargeted metabolomics analysis of urine samples collected from male e-waste processing workers to explore metabolic changes associated with chemical exposures in e-waste recycling in Belgium, Finland, Latvia, Luxembourg, the Netherlands, Poland, and Portugal. Questionnaire data and urine samples were obtained from workers involved in the processing of e-waste (sorting, dismantling, shredding, pre-processing, metal, and non-metal processing), as well as from controls with no known occupational exposure. Pre- and post-shift urine samples were collected and analysed using ultrahigh-performance liquid chromatography-mass spectrometry (UPLC-MS). A total of 32 endogenous urinary metabolites were annotated with a Variable Importance in Projection (VIP) above 2, indicating that e-waste recycling is mainly associated with changes in steroid hormone and neurotransmitter metabolism, energy metabolism, bile acid biosynthesis, and inflammation. The highest VIP was observed for dopamine-o-quinone, which is linked to Parkinson’s disease. These and other changes in metabolism in workers employed in the processing of e-waste need further verification in targeted studies.
- HBM4EU e-waste study – Occupational exposure assessment to chromium, cadmium, mercury and lead during e-waste recyclingPublication . Leese, Elizabeth; Verdonck, Jelle; Porras, Simo P.; Airaksinen, Jaakko; Duca, Radu C.; Galea, Karen S.; Godderis, Lode; Janasik, Beata; Mahiout, Selma; Martins, Carla; Mārtiņsone, Inese; Ani, Maria Mirela; van Nieuwenhuyse, An; Scheepers, Paul T.J.; Silva, Maria João; Viegas, Susana; Santonen, Tiina; HBM4EU E-waste Study TeamProcessing of electronic waste (e-waste) causes the release of toxic substances which may lead to occupational exposure. The study aimed to gather information on potential occupational exposure during e-waste recycling, with a focus on biomonitoring of chromium, cadmium, mercury and lead. In eight European countries, 195 workers involved in the recycling of lead batteries, white goods, brown goods and metals and plastics were studied. These workers were compared to 73 controls with no direct involvement of e-waste recycling or other metal processing activities. The samples collected consisted of urine, blood and hair samples, along with personal air samples, hand wipes, settled dust samples and contextual information. Chromium, cadmium, mercury and lead was measured in urine, hair, air samples, hand wipes and settled dust; cadmium and lead in whole blood and chromium in red blood cells. Results showed that lead exposure is of concern, with workers from all five types of e-waste showing exposure, with elevated measurements in all matrices. Internal exposure markers were positively correlated with markers of external exposure, indicating workers are not adequately protected. Exposure to mercury and cadmium was also observed but to a much lesser extent with raised cadmium concentrations in urine and blood of all workers when compared to controls and raised mercury concentrations were found in brown goods workers when compared to controls. This study has highlighted exposure concerns when processing e-waste, particularly for lead across all waste categories studied, indicating a need for improved control measures in this sector.
- Guidance on minimum information requirements (MIR) from designing to reporting human biomonitoring (HBM)Publication . Jeddi, Maryam Zare; Galea, Karen S.; Ashley-Martin, Jillian; Nassif, Julianne; Pollock, Tyler; Poddalgoda, Devika; Kasiotis, Konstantinos M.; Esteban-López, Marta; Chung, Ming Kei; Kil, Jihyon; Jones, Kate; Covaci, Adrian; Ait Bamai, Yu; Fernandez, Mariana F.; Pasanen Kase, Robert; Louro, Henriqueta; Silva, Maria J.; Santonen, Tiina; Katsonouri, Andromachi; Castaño, Argelia; Quirós-Alcalá, Lesliam; Argelia Castaño; Lesliam Quirós-Alcalá; Lin, Elizabeth Ziying; Pollitt, Krystal; Ana Virgolino; Virgolino, Ana; Scheepers, Paul T.J; Mustieles, Vicente; Cañas-Portilla, Ana Isabel; Viegas, Susana; von Goetz, Natalie; Sepai, Ovnair; Bird, Emily; Gӧen, Thomas; Fustinoni, Silvia; Ghosh, Manosij; Dirven, Hubert; Kwon, Jung-Hwan; Carignan, Courtney; Mizuno, Yuki; Ito, Yuki; Xia, Yankai; Shoji F. Nakayama; Nakayama, Shoji F.; Makris, Konstantinos C.; Parsons, Patrick J.; Gonzales, Melissa; Bader, Michael; Dusinska, Maria; Menouni, Aziza; Duca, Radu Corneliu; Chbihi, Kaoutar; El Jaafari, Samir; Godderis, Lode; van Nieuwenhuyse, An; Qureshi, Asif; Ali, Imran; Costa Trindade, Carla; Teixeira, Joao Paulo; Bartonova, Alena; Tranfo, Giovanna; Audouze, Karine; Verpaele, Steven; LaKind, Judy; Mol, Hans; Bessems, Jos; Magagna, Barbara; Nasution Waras, Maisarah; Connolly, Alison; Nascarella, Marc; Yang, Wonho; Huang, Po-Chin; Heussen, Henri; Goksel, Ozlem; Yunesian, Masud; Yeung, Leo W.Y.; Souza, Gustavo; Vekic, Ana Maria; Haynes, Erin N.; Hopf, Nancy B.Human biomonitoring (HBM) provides an integrated chemical exposures assessment considering all routes and sources of exposure. The accurate interpretation and comparability of biomarkers of exposure and effect depend on harmonized, quality-assured sampling, processing, and analysis. Currently, the lack of broadly accepted guidance on minimum information required for collecting and reporting HBM data, hinders comparability between studies. Furthermore, it prevents HBM from reaching its full potential as a reliable approach for assessing and managing the risks of human exposure to chemicals. The European Chapter of the International Society of Exposure Science HBM Working Group (ISES Europe HBM working group) has established a global human biomonitoring community network (HBM Global Network) to develop a guidance to define the minimum information to be collected and reported in HBM, called the “Minimum Information Requirements for Human Biomonitoring (MIR-HBM)”. This work builds on previous efforts to harmonize HBM worldwide. The MIR-HBM guidance covers all phases of HBM from the design phase to the effective communication of results. By carefully defining MIR for all phases, researchers and health professionals can make their HBM studies and programs are robust, reproducible, and meaningful. Acceptance and implementation of MIR-HBM Guidelines in both the general population and occupational fields would improve the interpretability and regulatory utility of HBM data. While implementation challenges remain—such as varying local capacities, and ethical and legal differences at the national levels, this initiative represents an important step toward harmonizing HBM practice and supports an ongoing dialogue among policymakers, legal experts, and scientists to effectively address these challenges. Leveraging the data and insights from HBM, policymakers can develop more effective strategies to protect public health and ensure safer working environments.