title: Burden of disease and costs of exposure to endocrine disrupting chemicals in the European Union: an updated analysis.
abstract: A previous report documented that endocrine disrupting chemicals contribute substantially to certain forms of disease and disability. In the present analysis, our main objective was to update a range of health and economic costs that can be reasonably attributed to endocrine disrupting chemical exposures in the European Union, leveraging new burden and disease cost estimates of female reproductive conditions from accompanying report. Expert panels evaluated the epidemiologic evidence, using adapted criteria from the WHO Grading of Recommendations Assessment, Development and Evaluation Working Group, and evaluated laboratory and animal evidence of endocrine disruption using definitions recently promulgated by the Danish Environmental Protection Agency. The Delphi method was used to make decisions on the strength of the data. Expert panels consensus was achieved for probable (>20%) endocrine disrupting chemical causation for IQ loss and associated intellectual disability; autism; attention deficit hyperactivity disorder; endometriosis; fibroids; 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 annual cost of €163 billion (1.28% of EU Gross Domestic Product) across 1000 simulations. We conclude that endocrine disrupting chemical 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 endocrine disrupting chemicals with the highest probability of causation; a broader analysis would have produced greater estimates of burden of disease and costs.
authors.affiliation: New York University (NYU) School of Medicine, New York, NY, USA.|NYU Wagner School of Public Service, New York, NY, USA.|Department of Nutrition, Food & Public Health, NYU Steinhardt School of Culture, Education and Human Development, New York, NY, USA.|NYU Global Institute of Public Health, New York University, New York, NY, USA.
authors.forename: L
authors.initials: L
authors.lastname: Trasande
authors.affiliation: University of Massachusetts, Amherst, MA, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Zoeller
authors.affiliation: National Food Institute, Technical University of Denmark, Søborg, Denmark.
authors.forename: U
authors.initials: U
authors.lastname: Hass
authors.affiliation: Institute of Environment, Health and Societies, Brunel University, Uxbridge, Middlesex, UK.
authors.forename: A
authors.initials: A
authors.lastname: Kortenkamp
authors.affiliation: Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.|University of Southern Denmark, Odense, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Grandjean
authors.affiliation: Environmental Health Sciences, Charlottesville, VA, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Myers
authors.affiliation: IPEN, Gothenburg, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: DiGangi
authors.affiliation: School of Molecular Biosciences, Washington State University, Pullman, WA, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Hunt
authors.affiliation: Silent Spring Institute, Newton, MA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Rudel
authors.affiliation: Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Sathyanarayana
authors.affiliation: EHESP School of Public Health, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Bellanger
authors.affiliation: Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Hauser
authors.affiliation: Department of Chemistry and Biology, Institute for Environmental Studies, VU University, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Legler
authors.affiliation: Department of Growth and Reproduction, Rigshospitalet, EDMaRC and University of Copenhagen, Copenhagen, Denmark.
authors.forename: N E
authors.initials: NE
authors.lastname: Skakkebaek
authors.affiliation: Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Heindel
mesh_terms: D017281:Cost of Illness; D052244:Endocrine Disruptors / Q000191:economics* / Q000633:toxicity; D004781:Environmental Exposure / Q000009:adverse effects / Q000191:economics*; D005062:European Union; D006801:Humans; D008962:Models, Theoretical; D009010:Monte Carlo Method
chemical_list: D052244:Endocrine Disruptors
keywords: disease burden; economic costs; endocrine disrupting chemicals