Application of systematic evidence mapping to assess the impact of new literature when updating health reference values: A case example using Uranium
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Systematic evidence mapping (SEM) provides a transparent and methodologically rigorous approach for compiling the available evidence to assess potential human health hazards. The objective of this analysis is to evaluate the applicability of evidence mapping to determine whether new evidence is likely to result in a change to an existing health reference value, using oral exposure to uranium as a case example. New literature published since the 2013 ATSDR’s Toxicological Profile is being used to assess potential health effects of uranium. A literature search for uranium from 2011 to early 2022 was retrieved to explore newly available data. Epidemiological and toxicological endpoints were screened according to Populations, Exposure, Comparators and Outcomes (PECO) criteria and analyzed to compare against principal health outcomes from the 2013 ATSDR Toxicological Profile using new evidence. Studies that met PECO criteria were examined for study confidence and considered for hazard evaluation and development of evidence integration conclusions. The hazard outcomes included: cardiometabolic, endocrine, immune, musculoskeletal, and respiratory effects. For dose-response re-analysis the following established effects will be considered: urinary, developmental, hepatic, neurological, and reproductive effects. Following the identification of these outcomes, evidence synthesis is being conducted for newly identified studies. This approach leverages existing assessments to develop a literature search strategy to understand the potential impact of new studies and focus the analysis on the new evidence that can inform hazard evaluation and dose-response and possibly aid in revising an existing health reference value. Disclaimer: The views expressed are those of the authors and do not necessarily represent the views or policies of the US EPA.