Scientific Concept of the National Cohort (status ... - Nationale Kohorte

A.3
A.3 Study design
certain foods) and the measurement of biomarkers of intake. This combination will allow for
a more valid dietary assessment without compromising the study participants by extensive
dietary records. Thus, the chosen approach is judged both feasible and cost-effective. For
participants without internet access, a paper or a touch screen version will be available.
For calibration issues and portion size definition, exact 24-h diet recalls will be collected in
a subgroup of the cohort, using a validated computer-assisted telephone interview (EPIC-
SOFT).
Environmental exposures
The evaluation of environmental risk factors such as air pollution with particulate matter or
noise pollution is important because they are widespread in the population and may have a
large public health impact in spite of small RRs since highly prevalent exposures may lead
to large attributable risks.
Outdoor exposure to air pollution: Associations between particulate matter and mortality
have been reported 417 , which resulted in tightening of the particulate matter standard in the
European Union in 2005. In spite of the improvement in standards, particulate matter and
gaseous pollution from traffic-related sources remains a matter of continuous concern 422 ,
and the impact of traffic-related exposures is an important part of the assessment of environmental
exposures. Noise exposure and exposure to high or low temperature are further
outdoor factors to be analyzed as potential risk factors for chronic diseases.
Instruments:
Recording of the home and work address (together with the participants consent to retrieve
the residential history from official registries), and the usual commuting pattern (mode of
transport used and duration) will be collected by questionnaire in the entire cohort. These
will form the basis for linkage with geographically coded exposure information for air pollution,
noise, and temperature. Spatially and temporally resolved maps for PM10, PM2,5,
SO2, NO2, O3, ultrafine particles, and elemental and organic carbon will be developed
independently to assign exposure status to the geocoded residential and workplace addresses.
Maps spatially resolved for noise exposure (considering differences between day
and night time and in cooperating commuting times and work place exposures) as well as
maps spatially resolved for temperature exposure (considering differences between seasons)
will be developed and can be applied for the benefit of the National Cohort.
It is important to note that based on geographic information system (GIS) tools, other emerging
exposures can be added during the course of the study. Thus, a flexible tool is being
established. We propose to establish the GIS databases at different physical locations and
separately from the health data. Only the derived exposure estimates but not the geocodes
for addresses would be merged to the health data. Thus, confidentiality issues are taken
into consideration while the novel and powerful GIS tool can be exploited as part of the
National Cohort.
Ionizing radiation: Man-made exposure to ionizing radiation is dominated by exposure to
medical radiation, predominantly for diagnostic purposes 535 . Medical radiation exposure is
emerging as an important public health issue, but there is a lack of information on the distribution
of exposure in the population, particularly in relation to age, sex, and diagnoses.
Moreover, it is important to analyze the contribution of medical radiation exposure to chronic
disease occurrence, e.g., to assess an association with cancer and well-defined noncancer
endpoints, and to prospectively monitor the distribution of medical exposure in Germany
based on individually collected data.
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