In this study, we propose an Environmental Risk Score (ERS) as a novel approach that integrates information on the health effects of multiple pollutant exposures. We used serum lipid measures and various classes of pollutant biomonitoring data from NHANES to illustrate and validate this approach. Important environmental risk factors for lipid outcomes were identified individually (single-phenotype approach) or together (multi-phenotype approach) while controlling for socio-demographic risk factors and nutrients. Although the contributions of ERS to overall risk predictions for lipid outcomes (i.e., R2, PRESS and AUC) were modest after accounting for important socio-demographic factors and nutrients, we found relatively stronger associations between ERS and lipid outcomes than with individual pollutants. The magnitudes of the observed associations between ERS and lipid outcomes were comparable to or stronger than those for socio-demographic factors or BMI.
