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Considerable variation in ferritin levels within and between individuals has been observed, but our current understanding of factors that explain this variation is far from complete. We aim to combine multiple potential determinants in an integrative model, and investigate their relative importance and potential interactions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We use ferritin measurements collected by Sanquin Blood Bank on both prospective (<jats:italic>N<\/jats:italic>\u00a0=\u200959\u2009596) and active blood donors (<jats:italic>N<\/jats:italic>\u00a0=\u200978\u2009318) to fit a structural equation model with three latent constructs (individual characteristics, donation history, and environmental factors). Parameters were estimated separately by sex and donor status.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The model explained 25% of ferritin variance in prospective donors, and 40% in active donors. Individual characteristics and donation history were the most important determinants of ferritin levels in active donors. The association between environmental factors and ferritin was smaller but still substantial; higher exposure to air pollution was associated with higher ferritin levels, and this association was considerably stronger for active blood donors than for prospective donors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>In active donors, individual characteristics explain 20% (17%) of ferritin variation, donation history explains 14% (25%) and environmental factors explain 5% (4%) for women (men). Our model presents known ferritin determinants in a broader perspective, allowing for comparison with other determinants as well as between new and active donors, or between men and women.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tme.12902","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T03:19:13Z","timestamp":1660101553000},"page":"113-122","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Individual and environmental determinants of serum ferritin levels: A structural equation model"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5653-8078","authenticated-orcid":false,"given":"Marieke","family":"Vinkenoog","sequence":"first","affiliation":[{"name":"Transfusion Technology Assessment, Department of Donor Medicine Research Sanquin Research  Amsterdam The Netherlands"},{"name":"Leiden Institute of Advanced Computer Science Leiden University  Leiden The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosa","family":"de Groot","sequence":"additional","affiliation":[{"name":"Donor Studies, Department of Donor Medicine Research Sanquin Research  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeroen","family":"Lakerveld","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC VU University  Amsterdam The Netherlands"},{"name":"Upstream Team, Amsterdam UMC VU University  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1682-7817","authenticated-orcid":false,"given":"Mart","family":"Janssen","sequence":"additional","affiliation":[{"name":"Transfusion Technology Assessment, Department of Donor Medicine Research Sanquin Research  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katja","family":"van den Hurk","sequence":"additional","affiliation":[{"name":"Donor Studies, Department of Donor Medicine Research Sanquin Research  Amsterdam The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,8,9]]},"reference":[{"key":"e_1_2_9_2_1","first-page":"164","article-title":"Review on iron and its importance for human health","volume":"19","author":"Abbaspour N","year":"2014","journal-title":"J Res Med Sci"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1159\/000362888"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/voxs.12527"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.15906"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(19)30106-1"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2011.03401.x"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/MOH.0b013e32836589f2"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1038\/ijo.2008.154"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2019.229450"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1079\/PNS2004394"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/s42003-020-01575-z"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cll.2014.10.011"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.15448"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.119"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0220862"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/9394060"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.5114\/aoms.2016.58928"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/08958370500224482"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/08958370701280481"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12942-021-00260-6"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2018-001017"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12942-020-00235-z"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.4324\/9780203843130"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.3758\/s13428-015-0619-7"},{"key":"e_1_2_9_26_1","unstructured":"R Core Team.R: A Language and Environment for Statistical Computing; 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