Estimating burden and disease costs of exposure to endocrine-disrupting chemicals in the European union

Leonardo Trasande, R Thomas Zoeller, Ulla Hass, Andreas Kortenkamp, Philippe Grandjean, John Peterson Myers, Joseph DiGangi, Martine Bellanger, Russ Hauser, Juliette Legler, Niels E Skakkebaek, Jerrold J Heindel

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

CONTEXT: Rapidly increasing evidence has documented that endocrine-disrupting chemicals (EDCs) contribute substantially to disease and disability.

OBJECTIVE: The objective was to quantify a range of health and economic costs that can be reasonably attributed to EDC exposures in the European Union (EU).

DESIGN: A Steering Committee of scientists adapted the Intergovernmental Panel on Climate Change weight-of-evidence characterization for probability of causation based upon levels of available epidemiological and toxicological evidence for one or more chemicals contributing to disease by an endocrine disruptor mechanism. To evaluate the epidemiological evidence, the Steering Committee adapted the World Health Organization Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria, whereas the Steering Committee adapted definitions recently promulgated by the Danish Environmental Protection Agency for evaluating laboratory and animal evidence of endocrine disruption. Expert panels used the Delphi method to make decisions on the strength of the data.

RESULTS: Expert panels achieved consensus at least for probable (>20%) EDC causation for IQ loss and associated intellectual disability, autism, attention-deficit hyperactivity disorder, 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 cost of €157 billion (or $209 billion, corresponding to 1.23% of EU gross domestic product) annually across 1000 simulations. Notably, using the lowest end of the probability range for each relationship in the Monte Carlo simulations produced a median range of €109 billion that differed modestly from base case probability inputs.

CONCLUSIONS: EDC 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 EDCs with the highest probability of causation; a broader analysis would have produced greater estimates of burden of disease and costs.

OriginalsprogEngelsk
TidsskriftJournal of Clinical Endocrinology and Metabolism
Vol/bind100
Udgave nummer4
Sider (fra-til)1245-55
ISSN0021-972X
DOI
StatusUdgivet - apr. 2015

Fingeraftryk

Endocrine Disruptors
Cost of Illness
European Union
Causality
United States Environmental Protection Agency
Cryptorchidism
Pediatric Obesity
Male Infertility
Consensus
Weights and Measures

Citer dette

Trasande, Leonardo ; Zoeller, R Thomas ; Hass, Ulla ; Kortenkamp, Andreas ; Grandjean, Philippe ; Myers, John Peterson ; DiGangi, Joseph ; Bellanger, Martine ; Hauser, Russ ; Legler, Juliette ; Skakkebaek, Niels E ; Heindel, Jerrold J. / Estimating burden and disease costs of exposure to endocrine-disrupting chemicals in the European union. I: Journal of Clinical Endocrinology and Metabolism. 2015 ; Bind 100, Nr. 4. s. 1245-55.
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title = "Estimating burden and disease costs of exposure to endocrine-disrupting chemicals in the European union",
abstract = "CONTEXT: Rapidly increasing evidence has documented that endocrine-disrupting chemicals (EDCs) contribute substantially to disease and disability.OBJECTIVE: The objective was to quantify a range of health and economic costs that can be reasonably attributed to EDC exposures in the European Union (EU).DESIGN: A Steering Committee of scientists adapted the Intergovernmental Panel on Climate Change weight-of-evidence characterization for probability of causation based upon levels of available epidemiological and toxicological evidence for one or more chemicals contributing to disease by an endocrine disruptor mechanism. To evaluate the epidemiological evidence, the Steering Committee adapted the World Health Organization Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria, whereas the Steering Committee adapted definitions recently promulgated by the Danish Environmental Protection Agency for evaluating laboratory and animal evidence of endocrine disruption. Expert panels used the Delphi method to make decisions on the strength of the data.RESULTS: Expert panels achieved consensus at least for probable (>20{\%}) EDC causation for IQ loss and associated intellectual disability, autism, attention-deficit hyperactivity disorder, 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 cost of €157 billion (or $209 billion, corresponding to 1.23{\%} of EU gross domestic product) annually across 1000 simulations. Notably, using the lowest end of the probability range for each relationship in the Monte Carlo simulations produced a median range of €109 billion that differed modestly from base case probability inputs.CONCLUSIONS: EDC 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 EDCs with the highest probability of causation; a broader analysis would have produced greater estimates of burden of disease and costs.",
author = "Leonardo Trasande and Zoeller, {R Thomas} and Ulla Hass and Andreas Kortenkamp and Philippe Grandjean and Myers, {John Peterson} and Joseph DiGangi and Martine Bellanger and Russ Hauser and Juliette Legler and Skakkebaek, {Niels E} and Heindel, {Jerrold J}",
year = "2015",
month = "4",
doi = "10.1210/jc.2014-4324",
language = "English",
volume = "100",
pages = "1245--55",
journal = "Journal of Clinical Endocrinology and Metabolism",
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Trasande, L, Zoeller, RT, Hass, U, Kortenkamp, A, Grandjean, P, Myers, JP, DiGangi, J, Bellanger, M, Hauser, R, Legler, J, Skakkebaek, NE & Heindel, JJ 2015, 'Estimating burden and disease costs of exposure to endocrine-disrupting chemicals in the European union', Journal of Clinical Endocrinology and Metabolism, bind 100, nr. 4, s. 1245-55. https://doi.org/10.1210/jc.2014-4324

Estimating burden and disease costs of exposure to endocrine-disrupting chemicals in the European union. / Trasande, Leonardo; Zoeller, R Thomas; Hass, Ulla; Kortenkamp, Andreas; Grandjean, Philippe; Myers, John Peterson; DiGangi, Joseph; Bellanger, Martine; Hauser, Russ; Legler, Juliette; Skakkebaek, Niels E; Heindel, Jerrold J.

I: Journal of Clinical Endocrinology and Metabolism, Bind 100, Nr. 4, 04.2015, s. 1245-55.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Estimating burden and disease costs of exposure to endocrine-disrupting chemicals in the European union

AU - Trasande, Leonardo

AU - Zoeller, R Thomas

AU - Hass, Ulla

AU - Kortenkamp, Andreas

AU - Grandjean, Philippe

AU - Myers, John Peterson

AU - DiGangi, Joseph

AU - Bellanger, Martine

AU - Hauser, Russ

AU - Legler, Juliette

AU - Skakkebaek, Niels E

AU - Heindel, Jerrold J

PY - 2015/4

Y1 - 2015/4

N2 - CONTEXT: Rapidly increasing evidence has documented that endocrine-disrupting chemicals (EDCs) contribute substantially to disease and disability.OBJECTIVE: The objective was to quantify a range of health and economic costs that can be reasonably attributed to EDC exposures in the European Union (EU).DESIGN: A Steering Committee of scientists adapted the Intergovernmental Panel on Climate Change weight-of-evidence characterization for probability of causation based upon levels of available epidemiological and toxicological evidence for one or more chemicals contributing to disease by an endocrine disruptor mechanism. To evaluate the epidemiological evidence, the Steering Committee adapted the World Health Organization Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria, whereas the Steering Committee adapted definitions recently promulgated by the Danish Environmental Protection Agency for evaluating laboratory and animal evidence of endocrine disruption. Expert panels used the Delphi method to make decisions on the strength of the data.RESULTS: Expert panels achieved consensus at least for probable (>20%) EDC causation for IQ loss and associated intellectual disability, autism, attention-deficit hyperactivity disorder, 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 cost of €157 billion (or $209 billion, corresponding to 1.23% of EU gross domestic product) annually across 1000 simulations. Notably, using the lowest end of the probability range for each relationship in the Monte Carlo simulations produced a median range of €109 billion that differed modestly from base case probability inputs.CONCLUSIONS: EDC 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 EDCs with the highest probability of causation; a broader analysis would have produced greater estimates of burden of disease and costs.

AB - CONTEXT: Rapidly increasing evidence has documented that endocrine-disrupting chemicals (EDCs) contribute substantially to disease and disability.OBJECTIVE: The objective was to quantify a range of health and economic costs that can be reasonably attributed to EDC exposures in the European Union (EU).DESIGN: A Steering Committee of scientists adapted the Intergovernmental Panel on Climate Change weight-of-evidence characterization for probability of causation based upon levels of available epidemiological and toxicological evidence for one or more chemicals contributing to disease by an endocrine disruptor mechanism. To evaluate the epidemiological evidence, the Steering Committee adapted the World Health Organization Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria, whereas the Steering Committee adapted definitions recently promulgated by the Danish Environmental Protection Agency for evaluating laboratory and animal evidence of endocrine disruption. Expert panels used the Delphi method to make decisions on the strength of the data.RESULTS: Expert panels achieved consensus at least for probable (>20%) EDC causation for IQ loss and associated intellectual disability, autism, attention-deficit hyperactivity disorder, 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 cost of €157 billion (or $209 billion, corresponding to 1.23% of EU gross domestic product) annually across 1000 simulations. Notably, using the lowest end of the probability range for each relationship in the Monte Carlo simulations produced a median range of €109 billion that differed modestly from base case probability inputs.CONCLUSIONS: EDC 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 EDCs with the highest probability of causation; a broader analysis would have produced greater estimates of burden of disease and costs.

U2 - 10.1210/jc.2014-4324

DO - 10.1210/jc.2014-4324

M3 - Journal article

C2 - 25742516

VL - 100

SP - 1245

EP - 1255

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 4

ER -