Exposure to endocrine-disrupting chemicals in the USA: a population-based disease burden and cost analysis
Exposure to endocrine-disrupting chemicals in the USA: a population-based disease burden and cost analysis
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DOI：
10.1016/s2213-8587(16)30275-3
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发表时间：
2016-12-01
影响因子：
44.5
通讯作者：
Trasande, Leonardo
中科院分区：
文献类型：
--
作者：
Attina, Teresa M.;Hauser, Russ;Trasande, Leonardo
背景内分泌干扰物(EDCs)会导致疾病和功能障碍，并导致高昂的相关成本(占欧盟国内生产总值(GDP)的1%)。由于法规的不同，美国和欧洲接触EDCs的情况差异很大，因此，我们的目标是量化疾病负担和相关的经济成本，以便进行比较。方法我们使用现有的流行病学和毒理学研究评估模型，就15种物质与疾病之间暴露-反应关系的因果概率达成共识。我们使用蒙特卡罗方法，在考虑了不确定性的情况下，为暴露-反应关系中的成本产生了真实的概率范围。估计是根据2010年美国的人口和成本做出的。欧盟的费用被转换为美元((原文如此)1=1.33美元)。结果发现，美国的EDC的疾病成本远高于欧洲(3400亿美元[GDP的2.33%]对2170亿美元[1.28%])。这主要是由多溴联苯醚导致的智商下降和智力残疾所致(在美国，智商下降了1100万分，损失了43000例，损失了2660亿美元；在欧盟，损失了873000点，损失了3290例，损失了126亿美元)。考虑到因果关系的可能性，在欧盟，有机磷农药是与EDC暴露相关的成本的最大贡献者(1210亿美元)，而在美国，与农药有关的成本要低得多(420亿美元)。美国EDC暴露导致疾病和功能障碍，每年的成本占GDP的2%以上。与欧盟的不同表明，有必要改进对内分泌系统的化学干扰的筛查和积极预防。
Background Endocrine-disrupting chemicals (EDCs) contribute to disease and dysfunction and incur high associated costs (>1% of the gross domestic product [GDP] in the European Union). Exposure to EDCs varies widely between the USA and Europe because of differences in regulations and, therefore, we aimed to quantify disease burdens and related economic costs to allow comparison.Methods We used existing models for assessing epidemiological and toxicological studies to reach consensus on probabilities of causation for 15 exposure-response relations between substances and disorders. We used Monte Carlo methods to produce realistic probability ranges for costs across the exposure-response relation, taking into account uncertainties. Estimates were made based on population and costs in the USA in 2010. Costs for the European Union were converted to US$ ((sic)1=$1.33).Findings The disease costs of EDCs were much higher in the USA than in Europe ($340 billion [2.33% of GDP] vs $217 billion [1.28%]). The difference was driven mainly by intelligence quotient (IQ) points loss and intellectual disability due to polybrominated diphenyl ethers (11 million IQ points lost and 43 000 cases costing $266 billion in the USA vs 873 000 IQ points lost and 3290 cases costing $12.6 billion in the European Union). Accounting for probability of causation, in the European Union, organophosphate pesticides were the largest contributor to costs associated with EDC exposure ($121 billion), whereas in the USA costs due to pesticides were much lower ($42 billion).Interpretation EDC exposure in the USA contributes to disease and dysfunction, with annual costs taking up more than 2% of the GDP. Differences from the European Union suggest the need for improved screening for chemical disruption to endocrine systems and proactive prevention.