Neurobehavioral deficits, diseases, and associated costs of exposure to endocrine-disrupting chemicals in the European Union.
BACKGROUND
Epidemiological studies and animal models demonstrate that endocrine-disrupting chemicals (EDCs) contribute to cognitive deficits and neurodevelopmental disabilities.


OBJECTIVE
The objective was to estimate neurodevelopmental disability and associated costs that can be reasonably attributed to EDC exposure in the European Union.


METHODS
An expert panel applied a weight-of-evidence characterization adapted from 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 approximate burden of disease. Cost estimation as of 2010 utilized lifetime economic productivity estimates, lifetime cost estimates for autism spectrum disorder, and annual costs for attention-deficit hyperactivity disorder. Setting, Patients and Participants, and Intervention: Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss.


RESULTS
The panel identified a 70-100% probability that polybrominated diphenyl ether and organophosphate exposures contribute to IQ loss in the European population. Polybrominated diphenyl ether exposures were associated with 873,000 (sensitivity analysis, 148,000 to 2.02 million) lost IQ points and 3290 (sensitivity analysis, 3290 to 8080) cases of intellectual disability, at costs of €9.59 billion (sensitivity analysis, €1.58 billion to €22.4 billion). Organophosphate exposures were associated with 13.0 million (sensitivity analysis, 4.24 million to 17.1 million) lost IQ points and 59 300 (sensitivity analysis, 16,500 to 84,400) cases of intellectual disability, at costs of €146 billion (sensitivity analysis, €46.8 billion to €194 billion). Autism spectrum disorder causation by multiple EDCs was assigned a 20-39% probability, with 316 (sensitivity analysis, 126-631) attributable cases at a cost of €199 million (sensitivity analysis, €79.7 million to €399 million). Attention-deficit hyperactivity disorder causation by multiple EDCs was assigned a 20-69% probability, with 19 300 to 31 200 attributable cases at a cost of €1.21 billion to €2.86 billion.


CONCLUSIONS
EDC exposures in Europe contribute substantially to neurobehavioral deficits and disease, with a high probability of >€150 billion costs/year. These results emphasize the advantages of controlling EDC exposure.
EHESP School of Public Health (M.B.), Paris, France; Unité Mixte de Recherche 7221 Centre National de la Recherche Scientifique/MNHN (B.D.), Muséum National d'Histoire Naturelle, 75005 Paris, France; Harvard School of Public Health (P.G.), Boston, Massachusetts 02115; University of Southern Denmark (P.G.), 5230 Odense, Denmark; University of Massachusetts (R.T.Z.), Amherst, Massachusetts 01003; 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.
Martine
M
Bellanger
Barbara
B
Demeneix
Philippe
P
Grandjean
R Thomas
RT
Zoeller
Leonardo
L
Trasande
D000293:Adolescent; D000328:Adult; 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; D002675:Child, Preschool; D017281:Cost of Illness; D052244:Endocrine Disruptors / Q000633:toxicity*; D004700:Endocrine System Diseases / Q000139:chemically induced / Q000191:economics* / Q000453:epidemiology; D004781:Environmental Exposure / Q000191:economics* / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005062:European Union / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000139:chemically induced / Q000191:economics / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000139:chemically induced / Q000191:economics* / Q000453:epidemiology
D052244:Endocrine Disruptors