title: Exposure to endocrine-disrupting chemicals in the USA: a population-based disease burden and cost analysis.
abstract: Endocrine-disrupting chemicals (EDCs) contribute to disease and dysfunction and incur high associated costs (>1% of the gross domestic product [GDP] in the European Union). Exposure to EDCs varies widely between the USA and Europe because of differences in regulations and, therefore, we aimed to quantify disease burdens and related economic costs to allow comparison.
  
  
  
  We used existing models for assessing epidemiological and toxicological studies to reach consensus on probabilities of causation for 15 exposure-response relations between substances and disorders. We used Monte Carlo methods to produce realistic probability ranges for costs across the exposure-response relation, taking into account uncertainties. Estimates were made based on population and costs in the USA in 2010. Costs for the European Union were converted to US$ (€1=$1·33).
  
  
  
  The disease costs of EDCs were much higher in the USA than in Europe ($340 billion [2·33% of GDP] vs $217 billion [1·28%]). The difference was driven mainly by intelligence quotient (IQ) points loss and intellectual disability due to polybrominated diphenyl ethers (11 million IQ points lost and 43 000 cases costing $266 billion in the USA vs 873 000 IQ points lost and 3290 cases costing $12·6 billion in the European Union). Accounting for probability of causation, in the European Union, organophosphate pesticides were the largest contributor to costs associated with EDC exposure ($121 billion), whereas in the USA costs due to pesticides were much lower ($42 billion).
  
  
  
  EDC exposure in the USA contributes to disease and dysfunction, with annual costs taking up more than 2% of the GDP. Differences from the European Union suggest the need for improved screening for chemical disruption to endocrine systems and proactive prevention.
  
  
  
  Endocrine Society, Ralph S French Charitable Foundation, and Broad Reach Foundation.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, NY, USA.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Attina
authors.affiliation: Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Russ
authors.initials: R
authors.lastname: Hauser
authors.affiliation: Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: Sheela
authors.initials: S
authors.lastname: Sathyanarayana
authors.affiliation: School of Molecular Biosciences, Washington State University, Pullman, WA, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Hunt
authors.affiliation: Paediatric Endocrinology, CHU Liège and Neuroendocrinology Unit, GIGA Neurosciences, Université de Liège, Liège, Belgium.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bourguignon
authors.affiliation: Environmental Health Sciences, Charlottesville, VA, USA.
authors.forename: John Peterson
authors.initials: JP
authors.lastname: Myers
authors.affiliation: International Persistent Organic Pollutant Elimination Network, Gothenburg, Sweden.
authors.forename: Joseph
authors.initials: J
authors.lastname: DiGangi
authors.affiliation: Department of Biology, University of Massachusetts, Amherst, MA, USA.
authors.forename: R Thomas
authors.initials: RT
authors.lastname: Zoeller
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, NY, USA; Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA; Department of Population Health, New York University School of Medicine, New York, NY, USA; New York University Wagner School of Public Service, New York, NY, USA; NYU Steinhardt School of Culture, Education and Human Development, Department of Nutrition, Food and Public Health, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA. Electronic address: leonardo.trasande@nyumc.org.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Trasande
mesh_terms: D000818:Animals; D017281:Cost of Illness; D003365:Costs and Cost Analysis; D052244:Endocrine Disruptors / Q000191:economics*; D004781:Environmental Exposure / Q000191:economics*; D006801:Humans; D014481:United States
chemical_list: D052244:Endocrine Disruptors