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Comparison of Trihalomethane exposure assessment metrics in epidemiologic analyses of reproductive and developmental outcomes

Abstract

Background

Researchers have developed exposure assessment metrics for disinfection by-products (DBPs) utilizing drinking water monitoring data and accounting for spatial and temporal variability, water consumption, and showering and bathing time with an expectation of decreasing exposure misclassification compared to the use of measured concentrations at public water supply (PWS) monitoring locations alone.

Objective

We used exposure data collected for a previous study of DBPs to evaluate how different sources of information impact trihalomethane (THM) exposure estimates.

Methods

We compared gestational exposure estimates to THMs based on water utility monitoring data alone, statistical imputation of daily concentrations to incorporate temporal variability, and personal water consumption and use (bathing and showering). We used Spearman correlation coefficients and ranked kappa statistics to compare exposure classifications.

Results

Exposure estimates based on measured or imputed daily THM concentrations, self-reported consumption, or bathing and showering differed substantially from estimates based solely on concentrations from PWS quarterly monitoring reports. Ranked exposure classifications, high to low quartiles or deciles, were generally consistent across each exposure metric (i.e., a subject with “high” exposure based on measured or imputed THM concentrations generally remained in the “high” category across exposure metrics.) The measured concentrations and imputed daily (i.e., spline regression) concentrations were highly correlated (r = 0.98). The weighted kappa statistics comparing exposure estimates using different exposure metrics ranged from 0.27 to 0.89, with the highest values for the ingestion + bathing/showering metrics compared to metrics for bathing/showering only (0.76 and 0.89). Bathing and showering contributed the most to “total” THM exposure estimates.

Impact Statement

We compare exposure metrics capturing temporal variability and multiple estimates of personal THM exposure with THM concentrations from PWS monitoring data. Our results show exposure estimates based on imputed daily concentrations accounting for temporal variability were very similar to the measured THM concentrations. We observed low agreement between imputed daily concentrations and ingestion-based estimates. Considering additional routes of exposure (e.g., inhalation and dermal) slightly increased agreement with the measured PWS exposure estimate in this population. Overall, the comparison of exposure assessment metrics allows researchers to understand the added value of additional data collection for future epidemiologic analyses of DBPs.

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Fig. 1: Agreement between ranked quartiles of prenatal THM4 exposure metrics.

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Data availability

All data used in these analyses were collected under the auspices of the National Birth Defects Prevention Study (NBDPS). Data that CDC collects or holds related to the NBDPS is made available for data sharing within a year after the data are evaluated for quality and shared with any partners in data collection activity. Because NBDPS data contain PII, NBDPS data are not released publicly. Instead, they are available via a special use agreement. Qualified researchers can be granted access to NBDPS data for analysis though collaboration with one of the Centers for Birth Defects Research and Prevention. The procedure for applying for access to NBDPS data can be found on the NBDPS Public Access Procedures web site: https://www.cdc.gov/ncbddd/birthdefects/nbdps-public-access-procedures.html.

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Acknowledgements

This project was supported through Centers for Disease Control and Prevention cooperative agreements under PA #96043, PA #02081, and FOA #DD09-001 to the Centers for Birth Defects Research and Prevention participating in the National Birth Defects Prevention Study (NBDPS), and the Arkansas Center for Birth Defects Prevention Study, grant/award number # U01DD00049. This study was funded in part by the Battelle Memorial Institute (PO 182124Mod 02). The funding sources were not involved in study design, data collection, analyses or interpretation of the data, in writing the report or in the decision to submit the paper for publication.

We thank the Arkansas Center for Health Statistics at the Arkansas Department of Health and the Arkansas Reproductive Health Monitoring System for providing data on cases and controls and the Environmental Health Services Division at the Arkansas Department of Health for providing community water system monitoring data for trihalomethanes. We thank Drs. Alison Krajewski and Andrey Egorov for early comments on the draft manuscript.

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Contributions

TJL, RMS, and JMW conceived and designed the study, WNN and KW provided the analytic sample and specified relevant exposure variables, EK developed PBPK-based exposure metrics, and TJL conducted the analyses. TJL, RMS, JMW, and JN interpreted the results. TJL, RMS EK, and JMW prepared the draft manuscript. WNN, KW, and JN reviewed the manuscript and provided substantial feedback. All authors reviewed the results and approved the final version of the manuscript.

Corresponding author

Correspondence to Thomas J. Luben.

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The authors declare no competing interests.

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This study protocol was approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill UNC IRB Number: 05-1420). The EPA’s Human Subjects Research Officer also reviewed and approved this work (HSR-001255).

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Luben, T.J., Shaffer, R.M., Kenyon, E. et al. Comparison of Trihalomethane exposure assessment metrics in epidemiologic analyses of reproductive and developmental outcomes. J Expo Sci Environ Epidemiol 34, 115–125 (2024). https://doi.org/10.1038/s41370-023-00559-5

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