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


METHODS
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.
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; NYU Global Institute of Public Health (L.T.), New York, New York 10003; University of Massachusetts (R.T.Z.), Amherst, Massachusetts 01003; National Food Institute (U.H.), Technical University of Denmark, 19 2860 Søborg, Denmark; Brunel University (A.K., R.H.), Institute of Environment, Health and Societies, Uxbridge, Middlesex UB8 3PH, United Kingdom; Department of Environmental Health (P.G.), Harvard T.H. Chan School of Public Health, Boston, Massachusetts 02115; University of Southern Denmark (P.G.), 5000 Odense, Denmark; Environmental Health Sciences (J.P.M.), Charlottesville, Virginia 22902; IPEN (J.D.), SE-402 35 Gothenburg, Sweden; EHESP School of Public Health (M.B.), 75014 Paris, France; Department of Chemistry and Biology (J.L.), Institute for Environmental Studies, VU University, 1081 HV Amsterdam, The Netherlands; Department of Growth and Reproduction (N.E.S.), Rigshospitalet, Endocrine Disruption of Male Reproduction and Child Health (EDMaRC) and University of Copenhagen, DK-2100 Copenhagen, Denmark; and National Institute of Environmental Health Sciences (J.J.H.), Division of Extramural Research and Training, Research Triangle Park, North Carolina 27709.
Leonardo
L
Trasande
R Thomas
RT
Zoeller
Ulla
U
Hass
Andreas
A
Kortenkamp
Philippe
P
Grandjean
John Peterson
JP
Myers
Joseph
J
DiGangi
Martine
M
Bellanger
Russ
R
Hauser
Juliette
J
Legler
Niels E
NE
Skakkebaek
Jerrold J
JJ
Heindel
D000328:Adult; D000368:Aged; D001289:Attention Deficit Disorder with Hyperactivity / Q000139:chemically induced / Q000191:economics / Q000453:epidemiology; D001321:Autistic Disorder / Q000139:chemically induced / Q000191:economics / Q000453:epidemiology; D002648:Child; D017281:Cost of Illness; D052244:Endocrine Disruptors / Q000633:toxicity*; D004700:Endocrine System Diseases / Q000191:economics* / Q000453:epidemiology; 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
D052244:Endocrine Disruptors; D004785:Environmental Pollutants