Obesity, diabetes, and associated costs of exposure to endocrine-disrupting chemicals in the European Union.
BACKGROUND
Obesity and diabetes are epidemic in the European Union (EU). Exposure to endocrine-disrupting chemicals (EDCs) is increasingly recognized as a contributor, independent of diet and physical activity.


OBJECTIVE
The objective was to estimate obesity, diabetes, and associated costs that can be reasonably attributed to EDC exposures in the EU.


METHODS
An expert panel evaluated evidence for probability of causation using weight-of-evidence characterization adapted from that applied by the Intergovernmental Panel on Climate Change. Exposure-response relationships and reference levels were evaluated for relevant EDCs, and biomarker data were organized from peer-reviewed studies to represent European exposure and burden of disease. Cost estimation as of 2010 utilized published cost estimates for childhood obesity, adult obesity, and adult diabetes. Setting, Patients and Participants, and Intervention: Cost estimation was performed from the societal perspective.


RESULTS
The panel identified a 40% to 69% probability of dichlorodiphenyldichloroethylene causing 1555 cases of overweight at age 10 (sensitivity analysis: 1555-5463) in 2010 with associated costs of €24.6 million (sensitivity analysis: €24.6-86.4 million). A 20% to 39% probability was identified for dichlorodiphenyldichloroethylene causing 28 200 cases of adult diabetes (sensitivity analysis: 28 200-56 400) with associated costs of €835 million (sensitivity analysis: €835 million-16.6 billion). The panel also identified a 40% to 69% probability of phthalate exposure causing 53 900 cases of obesity in older women and €15.6 billion in associated costs. Phthalate exposure was also found to have a 40% to 69% probability of causing 20 500 new-onset cases of diabetes in older women with €607 million in associated costs. Prenatal bisphenol A exposure was identified to have a 20% to 69% probability of causing 42 400 cases of childhood obesity, with associated lifetime costs of €1.54 billion.


CONCLUSIONS
EDC exposures in the EU contribute substantially to obesity and diabetes, with a moderate probability of >€18 billion costs per year. This is a conservative estimate; the results emphasize the need to control EDC exposures.
Department of Chemistry and Biology (J.L.), Institute for Environmental Studies, VU University, 1081 HV Amsterdam, The Netherlands; London School of Tropical Hygiene (T.F.), London WC1E 7HT, United Kingdom; Environmental Risk and Health (E.G.), Flemish Institute for Technological Research, 2400 Mol, Belgium; School of Medicine (M.P.), Universitat Autònoma de Barcelona, 08193 Barcelona, Spain; Hospital del Mar Institute of Medical Research (M.P.), 08003 Barcelona, Spain; Consorcio de Investigación Biomédica de Epidemiología y Salud Pública (CIBERESP) (M.P.), 28029 Madrid, Spain; Department of Developmental and Cell Biology (B.B.), University of California, Irvine, Irvine, California 92697; National Institute of Environmental Health Sciences (J.J.H.), Research Triangle Park, North Carolina 27709; New York University (NYU) School of Medicine (L.T.), New York, New York 10016; NYU Wagner School of Public Service (L.T.), New York, New York 10012; NYU Steinhardt School of Culture, Education, and Human Development (L.T.), Department of Nutrition, Food & Public Health, New York, New York 10003; and NYU Global Institute of Public Health (L.T.), New York, New York 10003.
Juliette
J
Legler
Tony
T
Fletcher
Eva
E
Govarts
Miquel
M
Porta
Bruce
B
Blumberg
Jerrold J
JJ
Heindel
Leonardo
L
Trasande
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D017281:Cost of Illness; D003920:Diabetes Mellitus / Q000139:chemically induced / Q000191:economics* / Q000453:epidemiology; D003633:Dichlorodiphenyl Dichloroethylene / Q000633:toxicity; D052244:Endocrine Disruptors / Q000633:toxicity*; D004781:Environmental Exposure / Q000191:economics* / Q000706:statistics & numerical data; D004785:Environmental Pollutants / Q000633:toxicity*; D005062:European Union / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000139:chemically induced / Q000191:economics* / Q000453:epidemiology; D050177:Overweight / Q000139:chemically induced / Q000191:economics / Q000453:epidemiology; D010795:Phthalic Acids / Q000633:toxicity
D052244:Endocrine Disruptors; D004785:Environmental Pollutants; D010795:Phthalic Acids; D003633:Dichlorodiphenyl Dichloroethylene; C032279:phthalic acid