title: Female Reproductive Disorders, Diseases, and Costs of Exposure to Endocrine Disrupting Chemicals in the European Union.
abstract: A growing body of evidence suggests that endocrine-disrupting chemicals (EDCs) contribute to female reproductive disorders.
  
  
  
  To calculate the associated combined health care and economic costs attributable to specific EDC exposures within the European Union (EU).
  
  
  
  An expert panel evaluated evidence for probability of causation using the Intergovernmental Panel on Climate Change weight-of-evidence characterization. Exposure-response relationships and reference levels were evaluated, and biomarker data were organized from carefully identified studies from the peer-reviewed literature to represent European exposure and approximate burden of disease as it occurred in 2010. Cost-of-illness estimation used multiple peer-reviewed sources.
  
  
  
  Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss.
  
  
  
  The most robust EDC-related data for female reproductive disorders exist for 1) diphenyldichloroethene-attributable fibroids and 2) phthalate-attributable endometriosis in Europe. In both cases, the strength of epidemiological evidence was rated as low and the toxicological evidence as moderate, with an assigned probability of causation of 20%–39%. Across the EU, attributable cases were estimated to be 56 700 and 145 000 women, respectively, with total combined economic and health care costs potentially reaching €163 million and €1.25 billion.
  
  
  
  EDCs (diphenyldichloroethene and phthalates) may contribute substantially to the most common reproductive disorders in women, endometriosis and fibroids, costing nearly €1.5 billion annually. These estimates represent only EDCs for which there were sufficient epidemiologic studies and those with the highest probability of causation. These public health costs should be considered as the EU contemplates regulatory action on EDCs.
authors.affiliation: School of Molecular Biosciences (P.A.H.), Washington State University, Pullman, Washington 99164; Center for Child Health, Behavior and Development (S.S.), Seattle Children's Research Institute, Seattle, Washington 98145; Department of Pediatrics (S.S.), University of Washington, Seattle, Washington 98145; Division of Applied Medicine (P.A.F.), Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, United Kingdom; 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; and Education and Human Development (L.T.), Department of Nutrition, Food and Public Health, NYU Steinhardt School of Culture New York, New York, New York 10013; NYU College of Global Public Health (L.T.), New York University, New York, New York 10003.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Hunt
authors.affiliation: School of Molecular Biosciences (P.A.H.), Washington State University, Pullman, Washington 99164; Center for Child Health, Behavior and Development (S.S.), Seattle Children's Research Institute, Seattle, Washington 98145; Department of Pediatrics (S.S.), University of Washington, Seattle, Washington 98145; Division of Applied Medicine (P.A.F.), Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, United Kingdom; 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; and Education and Human Development (L.T.), Department of Nutrition, Food and Public Health, NYU Steinhardt School of Culture New York, New York, New York 10013; NYU College of Global Public Health (L.T.), New York University, New York, New York 10003.
authors.forename: Sheela
authors.initials: S
authors.lastname: Sathyanarayana
authors.affiliation: School of Molecular Biosciences (P.A.H.), Washington State University, Pullman, Washington 99164; Center for Child Health, Behavior and Development (S.S.), Seattle Children's Research Institute, Seattle, Washington 98145; Department of Pediatrics (S.S.), University of Washington, Seattle, Washington 98145; Division of Applied Medicine (P.A.F.), Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, United Kingdom; 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; and Education and Human Development (L.T.), Department of Nutrition, Food and Public Health, NYU Steinhardt School of Culture New York, New York, New York 10013; NYU College of Global Public Health (L.T.), New York University, New York, New York 10003.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Fowler
authors.affiliation: School of Molecular Biosciences (P.A.H.), Washington State University, Pullman, Washington 99164; Center for Child Health, Behavior and Development (S.S.), Seattle Children's Research Institute, Seattle, Washington 98145; Department of Pediatrics (S.S.), University of Washington, Seattle, Washington 98145; Division of Applied Medicine (P.A.F.), Institute of Medical Sciences, University of Aberdeen, Aberdeen, AB25 2ZD, Scotland, United Kingdom; 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; and Education and Human Development (L.T.), Department of Nutrition, Food and Public Health, NYU Steinhardt School of Culture New York, New York, New York 10013; NYU College of Global Public Health (L.T.), New York University, New York, New York 10003.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Trasande
mesh_terms: D000328:Adult; D017281:Cost of Illness; D052244:Endocrine Disruptors / Q000009:adverse effects*; D004781:Environmental Exposure / Q000191:economics*; D004785:Environmental Pollutants / Q000009:adverse effects*; D005062:European Union; D005260:Female; D005831:Genital Diseases, Female / Q000139:chemically induced / Q000191:economics*; D006801:Humans; D055815:Young Adult
chemical_list: D052244:Endocrine Disruptors; D004785:Environmental Pollutants