Record linkage of human biomonitoring (HBM) survey data with administrative register data can be used to enhance available datasets and complement the possible shortcomings of both data sources. Through record linkage, valuable information on medical history (diagnosed diseases, medication use, etc.) and follow-up information on health and vital status for established cohorts can be obtained. In this study, we investigated the availability of health registers in different EU Member States and EEA countries and assessed whether they could be linked to HBM studies. We found that the availability of administrative health registers varied substantially between European countries as well as the availability of unique personal identifiers that would facilitate record linkage. General protocols for record linkage were similar in all countries with ethical and data protections approval, informed consent, approval by administrative register owner, and linkage conducted by the register owner. Record linkage enabled cross-sectional survey data to be used as cohort study data with available follow-up and health endpoints. This can be used for extensive exposure-health effect association analysis. Our study showed that this is possible for many, but not all European countries.

Department of Clinical Pharmacology Pharmacy and Environmental Medicine University of Southern Denmark 5230 Odense Denmark

Department of Environmental Health Center for Public Health Medical University Vienna 1090 Wien Austria

Department of Hygiene Medical University of Karakalpakstan Nukus 230100 Uzbekistan

Department of Public Health and Welfare Finnish Institute for Health and Welfare 00300 Helsinki Finland

Division of Climate and Environment Norwegian Institute of Public Health 0213 Oslo Norway

Faculty of Science RECETOX Masaryk University 62500 Brno Czech Republic

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University 62500 Brno Czech Republic

Institute of Environmental Medicine Karolinska Institutet 17177 Stockholm Sweden

Institute of Health and Information and Statistics of the Czech Republic 12801 Prague Czech Republic

Section of Sustainable Health Department of Public Health and Clinical Medicine Umeå University 90187 Umeå Sweden

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