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Cohort profile: LIFEWORK, a prospective cohort study on occupational and environmental risk factors and health in the Netherlands
  1. Marije Reedijk1,2,
  2. Virissa Lenters1,
  3. Pauline Slottje1,3,
  4. Anouk Pijpe4,
  5. Petra H Peeters2,5,
  6. Joke C Korevaar6,
  7. Bas Bueno-de-Mesquita5,7,
  8. W M Monique Verschuren2,7,
  9. Robert A Verheij6,
  10. Inka Pieterson1,
  11. Flora E van Leeuwen4,
  12. Matti A Rookus4,
  13. Hans Kromhout1,
  14. Roel C H Vermeulen1,2,5
  1. 1 Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
  2. 2 Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  3. 3 Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Utrecht, The Netherlands
  4. 4 Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
  5. 5 Department of Biostatistics and Epidemiology, Imperial College London, London, UK
  6. 6 Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
  7. 7 National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
  1. Correspondence to Roel C H Vermeulen; r.c.h.vermeulen{at}


Purpose LIFEWORK is a large federated prospective cohort established in the Netherlands to quantify the health effects of occupational and environmental exposures. This cohort is also the Dutch contribution to the international Cohort Study of Mobile Phone Use and Health (COSMOS). In this paper, we describe the study design, ongoing data collection, baseline characteristics of participants and the repeatability of key questionnaire items.

Participants 88 466 participants were enrolled in three cohort studies in 2011–2012. Exposure information was collected by a harmonised core questionnaire, or modelled based on occupational and residential histories; domains include air pollution (eg, nitrogen dioxide (NO2), particulate matter with diameter ≤2.5 µm (PM2.5)), noise, electromagnetic fields (EMF), mobile phone use, shift work and occupational chemical exposures. Chronic and subacute health outcomes are assessed by self-report and through linkage with health registries.

Findings to date Participants had a median age of 51 years at baseline (range 19–87), and the majority are female (90%), with nurses being over-represented. Median exposure levels of NO2, PM2.5, EMF from base stations and noise at the participants’ home addresses at baseline were 22.9 µg/m3, 16.6 µg/m3, 0.003 mWm2 and 53.1 dB, respectively. Twenty-two per cent of participants reported to have started using a mobile phone more than 10 years prior to baseline. Repeatability for self-reported exposures was moderate to high (weighted kappa range: 0.69–1) for a subset of participants (n=237) who completed the questionnaire twice.

Future plans We are actively and passively observing participants; we plan to administer a follow-up questionnaire every 4–5 years—the first follow-up will be completed in 2018—and linkage to cause-of-death and cancer registries occurs on a (bi)annual basis. This prospective cohort offers a unique, large and rich resource for research on contemporary occupational and environmental health risks and will contribute to the large international COSMOS study on mobile phone use and health.

  • electromagnetic fields
  • population-based studies
  • epidemiology
  • occupational and environmental exposures
  • repeatability

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  • PS and AP contributed equally.

  • MAR, HK and RCHV contributed equally.

  • MR and VL contributed equally.

  • Contributors MR, VL and RCHV conceived the present analysis and manuscript. MR contributed to data collection, performed the data analysis and drafted the manuscript, with contributions from VL. PS, AP, PHP, BBdM, WMMV, FEvL, MAR, HK and RCHV designed and established the LIFEWORK cohort and the contributing subcohorts (PS and RCHV: AMIGO; BBdM, WMMV and PHP: EPIC-NL; AP, RCHV, FEvL and MAR: Nightingale), and are also responsible for their continued management (as previous, except JCK, RAV and RCHV: AMIGO). HK and RCHV obtained funding for the LIFEWORK cohort. IP was responsible for data management. All authors reviewed, critically revised and approved the manuscript.

  • Funding This research was funded by the Netherlands Organisation for Health Research and Development (ZonMw) within the Electromagnetic Fields and Health Research programme (grant numbers 85200001 and 85500003), the National Institute for Public Health and the Environment (RIVM) and the Netherlands Cancer Institute. The EPIC-NL study was funded by ‘Europe against Cancer’ Programme of the European Commission (DG SANCO); the Dutch Ministry of Health, Welfare and Sports (VWS); the ZonMw; and the World Cancer Research Fund (WCRF). ESCAPE received funding from the European Community’s Seventh Framework Program (FP7/2007-2011) under grant agreement number 211250.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The contributing subcohorts were approved by the local research ethics review committee or institutional review board (AMIGO and EPIC-NL Prospect by the committee at the University Medical Center Utrecht; EPIC-NL MORGEN by the committee at TNO Nutrition and Food Research; and Nightingale by the committee at the Netherlands Cancer Institute), and participants signed an informed consent form for each subcohort prior to enrolment.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Available data are listed in online supplementary table S1. Researchers interested in collaboration are invited to propose occupational and environmental research based on the data available within LIFEWORK or to submit a request for additional data collection. Requests can be submitted to RCHV ( and will be reviewed by the LIFEWORK scientific board.

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