title: Burden of disease attributable to selected environmental factors and injury among children and adolescents in Europe.
abstract: BACKGROUND
  Environmental exposures contribute to the global burden of disease. We have estimated the burden of disease attributable to outdoor and indoor air pollution, inadequate water and sanitation, lead exposure, and injury among European children and adolescents.
  
  
  METHODS
  Published studies and reports from international agencies were reviewed for calculation of risk-factor exposure in Europe. Disability-adjusted life years (DALYs) or deaths attributable to each factor, or both, were estimated by application of the potential impact fraction to the estimates of mortality and burden of disease from the WHO global database of burden of disease.
  
  
  RESULTS
  Among children aged 0-4 years, between 1.8% and 6.4% of deaths from all causes were attributable to outdoor air pollution; acute lower-respiratory-tract infections attributable to indoor air pollution accounted for 4.6% of all deaths and 3.1% of DALYs; and mild mental retardation resulting from lead exposure accounted for 4.4% of DALYs. In the age-group 0-14 years, diarrhoea attributable to inadequate water and sanitation accounted for 5.3% of deaths and 3.5% of DALYs. In the age-group 0-19 years, injuries were the cause of 22.6% of all deaths and 19.0% of DALYs. The burden of disease was much higher in European subregions B and C than subregion A. There was substantial uncertainty around some of the estimates, especially for outdoor air pollution.
  
  
  CONCLUSIONS
  Large proportions of deaths and DALYs in European children are attributable to outdoor and indoor air pollution, inadequate water and sanitation, lead exposure, and injuries. Interventions aimed at reducing children's exposure to environmental factors and injuries could result in substantial gains. The pronounced differences by subregion and age indicate the need for targeted action.
authors.affiliation: Institute of Hygiene and Epidemiology, DPMSC, University Hospital, University of Udine, Italy. francesca.valent@uniud.it
authors.forename: Francesca
authors.initials: F
authors.lastname: Valent
authors.forename: D'Anna
authors.initials: D
authors.lastname: Little
authors.forename: Roberto
authors.initials: R
authors.lastname: Bertollini
authors.forename: Leda E
authors.initials: LE
authors.lastname: Nemer
authors.forename: Fabio
authors.initials: F
authors.lastname: Barbone
authors.forename: Giorgio
authors.initials: G
authors.lastname: Tamburlini
mesh_terms: D000293:Adolescent; D000328:Adult; D000397:Air Pollution / Q000009:adverse effects; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology; D004781:Environmental Exposure; D004782:Environmental Health; D004787:Environmental Pollution / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008607:Intellectual Disability / Q000453:epidemiology / Q000209:etiology; D007855:Lead Poisoning / Q000453:epidemiology / Q000209:etiology; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000401:mortality; D012306:Risk; D012307:Risk Factors; D012499:Sanitation; D014876:Water Pollution / Q000009:adverse effects; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality