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Licensed Unlicensed Requires Authentication Published by De Gruyter June 27, 2022

Using biomonitoring as a complementary approach in BTEX exposure assessment in the general population and occupational settings: a systematic review and meta-analysis

  • Mohammad Hoseini , Mohammad Reza Samaei , Armita Shahesmaeili , Susana Silva Martínez and Hoda Amiri EMAIL logo


Hazardous organic compounds such as benzene, toluene, ethylbenzene, o-xylene, m-xylene, and p-xylene (known as BTEX) found at work and at home can cause adverse health effects of human beings throughout their lives. Biological monitoring, an exposure assessment method, considers all exposed organic and non-organic compounds. Our goal was to perform a systematic review and a statistical analysis (meta-analysis) of peer-reviewed publications to assess urinary concentrations of BTEX biomarkers in both occupationally-exposed population and the general population. Several major electronic databases, including Scopus, Embase, Medline, Web of Science, and Google scholar (grey literature), were searched for biomonitoring studies of BTEX. Overall, 33 studies met the eligible criteria for the systematic review and six met the full inclusion criteria for meta-analysis. For meta-analysis, we included studies in which unmetabolized BTEX compounds were measured in urine samples. Due to insufficient data, studies that measured BTEX metabolites in urine samples and unmetabolized BTEX compounds in blood samples were excluded from the meta-analysis but were analyzed in the qualitative synthesis. Most studies showed increased urinary concentrations of BTEX in exposed individuals (mainly workers) compared to unexposed individuals. The results showed that the highest total BTEX concentrations were recorded in painters and policemen. This study showed that the undoubted associations between lifestyle and environmental factors and urinary levels of BTEX or its metabolites have not yet been confirmed in current biomonitoring studies. This is attributed to the few studies reported in this research area, the lack of homogeneous information, and the disagreement in the published results of the studies.

Corresponding author: Hoda Amiri, Environmental Health Engineering Research Center, Kerman University of Medical Sciences, Kerman, Iran; and Department of Environmental Health Engineering, Faculty of Public Health, Kerman University of Medical Sciences, Kerman, Iran, E-mail:


The authors thank the Environmental Health Engineering Research Center affiliated to Shiraz University of Medical Sciences for their scientific support.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: The conducted research is not related to either human or animal use.


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Received: 2022-02-28
Accepted: 2022-05-16
Published Online: 2022-06-27
Published in Print: 2023-09-26

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