Mapping drinking water and quality of life aspects in urban settings: an application of the urban exposome

Abstract

Cities face rapid changes leading to increasing inequalities and emerging public health issues that require cost-effective interventions. The urban exposome framework constitutes a novel approach in tackling city-wide challenges, such as those of drinking water quality and quality of life. In this proof-of-concept study, we presented part of the urban exposome of Limassol (Cyprus) focusing on chemical and microbial drinking water quality parameters and their association with urban neighborhood indicators. A perceptions study and an urban population study was conducted. We mapped the water quality parameters and participants’ opinions on city life (i.e. neighborhood life, health care and green space access) using quarters (small administrative areas) as the reference unit of the city. In an exploratory environment-wide association study analysis, we used all variables (questionnaire responses and water quality metrics) to describe correlations between them accounting, also, for self-reported health status. Overall, urban drinking-water quality using conventional indicators of chemical (disinfection byproducts-trihalomethanes) and microbial (coliforms, E. coli, and Enterococci) quality did not raise particular concerns. The general health and chronic health status of the urban participants were significantly (all >FDR corrected p value of 0.1) associated with different health conditions such as hypertension and asthma, or having financial issues in access to dental care. Additionally, correlations between trihalomethanes and participant characteristics (e.g. household cleaning, drinking water habits) were documented. This proof-of-concept study showed the potential of using integrative approaches to develop urban exposomic profiles and identifying within-city differentiated environmental and health indicators. The characterization of the urban exposome of Limassol will be expanded via the inclusion of biomonitoring tools and untargeted metabolomics platforms.

A Scoping Review on the Characteristics of Human Exposome Studies

“…On the other hand, Schisler et al [129] highlighted the importance of considering the "plasma exposome" as it comprises the functionality of all endothelial cells in the body, thus providing a comprehensive capture of the systemic inflammatory network. The "urban exposome" framework that was recently developed extends the utility of the human exposome into that of a city, considering the city elements as the main units of measuring a city's exposome, complementing that of the human exposome [73]. The above serve as examples of efforts towards further refining the exposome concept and its utility [9].…”

“…Seventeen of the retained studies had a cross-sectional design (21%) [73][74][75][76][77][78][79][80][81][82][83][84][85][86][87][88][89], and twelve were experimental (15%) (i.e., three randomized trials on metabolomic profile alterations [90,91] or clinical health outcomes [92] following administration of the experimental exposure; two open label cross-over trials exploring metabolomic and clinical effects of an experimental (juice) [93,94] or environmental (airborne and grass pollen) intervention [95], and seven experimental non-randomized studies). Five studies were case-control (6%) [94,[96][97][98][99] and three case-control studies nested in cohorts (4%) [100][101][102].…”

“…Four studies (5%) described the characteristics of exposome cohorts [53,127,72,55] and another (1%) characterized urban environmental and health indicators using the urban exposome framework [73]. Four studies (5%) explored the partitioning of a contaminant between environmental and human biospecimen, of which three considered a biomarker of exposure to environmental contaminants as a study outcome [117,115,80,116] , while only one study (1%) linked occupational records to health outcomes [109].…”

“…Novel agnostic tools of the exposome characterization were extensively used in 16 studies (20%), where 9 exposome studies (11%) employed the EWAS approach [50,63,73,61,67,69,79,86,107]; 3(4%) studies used the GWAS approach [71,78,92] and 2 (3%) used the so-called MWAS approach [84,88]; another publication (1%) [59] reported the use of an exposome-metabolome wide association study, and another one (1%) [108] employed both an EWAS and a GWAS approach.…”