Burden of disease and costs of exposure to endocrine disrupting chemicals in the European Union: an updated analysis.
Burden of disease and costs of exposure to endocrine disrupting chemicals in the European Union: an updated analysis.
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欧盟的疾病负担和接触内分泌干扰化学品的成本：最新分析。
DOI：
10.1111/andr.12178
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发表时间：
2016-07
期刊：
影响因子：
4.5
通讯作者：
Heindel JJ
中科院分区：
文献类型：
--
作者：
Trasande L;Zoeller RT;Hass U;Kortenkamp A;Grandjean P;Myers JP;DiGangi J;Hunt PM;Rudel R;Sathyanarayana S;Bellanger M;Hauser R;Legler J;Skakkebaek NE;Heindel JJ
先前的一份报告指出，干扰内分泌的化学品在很大程度上导致某些形式的疾病和残疾。在本分析中，我们的主要目标是更新一系列健康和经济成本，这些成本可以合理地归因于欧洲联盟内分泌干扰化学品暴露，利用随附报告中对女性生殖条件的新负担和疾病成本估计。专家小组使用世卫组织建议分级评估、制定和评价工作组的调整标准评价了流行病学证据，并使用丹麦环境保护局最近颁布的定义评价了内分泌干扰的实验室和动物证据。采用德尔菲法对数据的强度进行决策。专家小组就可能（>20%）的内分泌干扰化学品导致智商下降和相关智力残疾、自闭症、注意力缺陷多动障碍、子宫内膜异位症、子宫肌瘤、儿童肥胖症、成人肥胖症、成人糖尿病、隐睾症、男性不育症以及与睾酮减少相关的死亡率达成了共识。考虑到因果关系的概率，并使用因果关系概率的每个范围的中点，蒙特卡罗模拟在1000次模拟中产生了1630亿欧元（欧盟国内生产总值的1.28%）的年成本中位数。我们的结论是，在欧盟内分泌干扰化学品的暴露可能会大大有助于疾病和功能障碍的整个生命过程中的成本在数千亿欧元每年。这些估计数仅代表那些具有最高因果可能性的内分泌干扰化学品;更广泛的分析将产生更大的疾病负担和成本估计数。
A previous report documented that endocrine disrupting chemicals contribute substantially to certain forms of disease and disability. In the present analysis, our main objective was to update a range of health and economic costs that can be reasonably attributed to endocrine disrupting chemical exposures in the European Union, leveraging new burden and disease cost estimates of female reproductive conditions from accompanying report. Expert panels evaluated the epidemiologic evidence, using adapted criteria from the WHO Grading of Recommendations Assessment, Development and Evaluation Working Group, and evaluated laboratory and animal evidence of endocrine disruption using definitions recently promulgated by the Danish Environmental Protection Agency. The Delphi method was used to make decisions on the strength of the data. Expert panels consensus was achieved for probable (>20%) endocrine disrupting chemical causation for IQ loss and associated intellectual disability; autism; attention deficit hyperactivity disorder; endometriosis; fibroids; childhood obesity; adult obesity; adult diabetes; cryptorchidism; male infertility, and mortality associated with reduced testosterone. Accounting for probability of causation, and using the midpoint of each range for probability of causation, Monte Carlo simulations produced a median annual cost of €163 billion (1.28% of EU Gross Domestic Product) across 1000 simulations. We conclude that endocrine disrupting chemical exposures in the EU are likely to contribute substantially to disease and dysfunction across the life course with costs in the hundreds of billions of Euros per year. These estimates represent only those endocrine disrupting chemicals with the highest probability of causation; a broader analysis would have produced greater estimates of burden of disease and costs.