Neurobehavioral Deficits, Diseases, and Associated Costs of Exposure to Endocrine-Disrupting Chemicals in the European Union

Abstract

Context: Epidemiological studies and animal models demonstrate that endocrine disrupting chemicals (EDCs) contribute to cognitive deficits and neurodevelopmental disabilities.Objective: To estimate neurodevelopmental disability and associated costs that can be reasonably attributed to EDC exposure in the European Union.Design: 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 (ASD) and annual costs for attention deficit hyperactivity disorder (ADHD).Setting, Patients and Participants and Intervention: Cost estimation was carried out from a societalperspective, i.e. including direct costs (e.g. treatment costs) and indirect costs such as productivity loss.Results: The panel identified 70 –100% probability that polybrominated diphenyl ether (PBDE) and organophosphate (OP) exposures contribute to IQ loss in the European population. PBDE exposures were associated with 873,000 (sensitivity analysis: 148,000 –2.02 million) lost IQ points and 3,290 (sensitivity analysis: 3,290 – 8,080) cases of intellectual disability, at costs of €9.59 billion (sensitivity analysis: €1.58 –22.4 billion). OP exposures were associated with 13.0 billion (sensitivity analysis: 4.24 –17.1 billion) lost IQ points and 59,300 (sensitivity analysis: 16,500 – 84,400) cases of intellectual disability, at costs of€146 billion (sensitivity analysis:€46.8 –194 billion). ASD 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: €79.7–399 million). ADHD causation by multiple EDCs was assigned a 20 – 69% probability, with 19,300 –31,200 attributable cases at a cost of €1.21–2.86 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.