title: Burden of disease from toxic waste sites in India, Indonesia, and the Philippines in 2010.
abstract: BACKGROUND
  Prior calculations of the burden of disease from toxic exposures have not included estimates of the burden from toxic waste sites due to the absence of exposure data.
  
  
  OBJECTIVE
  We developed a disability-adjusted life year (DALY)-based estimate of the disease burden attributable to toxic waste sites. We focused on three low- and middle-income countries (LMICs): India, Indonesia, and the Philippines.
  
  
  METHODS
  Sites were identified through the Blacksmith Institute's Toxic Sites Identification Program, a global effort to identify waste sites in LMICs. At least one of eight toxic chemicals was sampled in environmental media at each site, and the population at risk estimated. By combining estimates of disease incidence from these exposures with population data, we calculated the DALYs attributable to exposures at each site.
  
  
  RESULTS
  We estimated that in 2010, 8,629,750 persons were at risk of exposure to industrial pollutants at 373 toxic waste sites in the three countries, and that these exposures resulted in 828,722 DALYs, with a range of 814,934-1,557,121 DALYs, depending on the weighting factor used. This disease burden is comparable to estimated burdens for outdoor air pollution (1,448,612 DALYs) and malaria (725,000 DALYs) in these countries. Lead and hexavalent chromium collectively accounted for 99.2% of the total DALYs for the chemicals evaluated.
  
  
  CONCLUSIONS
  Toxic waste sites are responsible for a significant burden of disease in LMICs. Although some factors, such as unidentified and unscreened sites, may cause our estimate to be an underestimate of the actual burden of disease, other factors, such as extrapolation of environmental sampling to the entire exposed population, may result in an overestimate of the burden of disease attributable to these sites. Toxic waste sites are a major, and heretofore underrecognized, global health problem.
authors: Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York 10029 , USA. kevin.chatham-stephens@mssm.edu
authors: Kevin
authors: K
authors: Chatham-Stephens
authors: Jack
authors: J
authors: Caravanos
authors: Bret
authors: B
authors: Ericson
authors: Jennifer
authors: J
authors: Sunga-Amparo
authors: Budi
authors: B
authors: Susilorini
authors: Promila
authors: P
authors: Sharma
authors: Philip J
authors: PJ
authors: Landrigan
authors: Richard
authors: R
authors: Fuller
mesh_terms: D017281:Cost of Illness; D004781:Environmental Exposure; D004784:Environmental Monitoring; D004785:Environmental Pollutants / Q000032:analysis / Q000633:toxicity*; D064371:Hazardous Waste Sites; D006801:Humans; D007194:India / Q000453:epidemiology; D007214:Indonesia / Q000453:epidemiology; D009026:Mortality; D010679:Philippines / Q000453:epidemiology; D019057:Quality-Adjusted Life Years
chemical_list: D004785:Environmental Pollutants
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