Exposure and dose

General concepts
Epidemiological studies on the effects of environmental
factors often deal with very specific factors that can be
measured quantitatively. The concepts of exposure and
dose are therefore particularly important in environmental
and occupational epidemiology.
Exposure has two dimensions: level and duration. For
environmental factors that cause acute effects more or less
immediately after exposure starts, the current exposure
level determines whether effects occur (for instance, the
“London smog epidemic” of deaths from lung and heart
disease, as shown in Figure 9.2, is one of the world’s first
major environmental disease outbreaks that was documented in detail).
However, many environmental factors produce effects only after a long period
of exposure. This is true of chemicals that accumulate in the body (for instance,
Figure 9.2. The London smog epidemic,12 December 1952
0
Deaths
(per day)
Days
5
750
500
250
0 10 15
0
SO2
ppm
Smoke
mg/m3
0.75
0.5
0.25
3.0
2.0
1.0
SO2
smoke
deaths
Pollution
concentration
Box 9.2. Epidemiological research on the health
effects of climate change
Emerging large-scale risks to population health are:
• global climate change
• degradation of arable land
• depletion of fisheries
• widespread shortage of fresh water
• losses of species and ecosystems.
Environmental and occupational epidemiology 149
cadmium) and hazards that have a cumulative effect (for instance, radiation or noise).
For these hazards, the past exposure levels and the exposure duration are more important
than the current exposure level. The total exposure (or external dose) needs
to be estimated. It is often approximated as the product of exposure duration and
exposure level.
In epidemiological studies, all kinds of estimates of exposure and dose have been
used to quantify the relationship between an environmental factor and the health
status of a population. For example, in Figure 1.1, the exposure is expressed in terms
of exposure level only (number of cigarettes smoked per day). Table 5.2 shows the
combined effect of duration and exposure level on noise-induced hearing loss. The
external dose can also be expressed as one combined measure, as with pack-years
for cigarette smoking and fibre-years (or particle-years) for asbestos exposure in the
workplace (Figure 9.3). Sometimes a proxy measure of exposure is used, such as the
traffic flow per hour in a particular place or the petrol consumption per year
as indicators of air pollution exposure. These variables could also be considered as
“pressure” indicators in the causal hierarchy (Chapter 5). Other examples would be
the use of pesticides in an area or the number of children living in houses painted
with lead-containing paint.13
Figure 9.3. Relationship between asbestos exposure (particle-years) and relative
risk of lung cancer14
1
4
2000 3000
Relative risk
Exposure (106 particles per cubic foot x years)