Estimating Burden and Disease Costs of Exposure to Endocrine-Disrupting Chemicals in the European Union

Abstract

Context: Rapidly increasing evidence has documented that endocrine-disrupting chemicals (EDCs)contribute substantially to disease and disability.Objective: To quantify a range of health and economic costs that can be reasonably attributed to EDC exposures in the European Union (EU).Design: A Steering Committee of scientists adapted the Intergovernmental Panel on Climate Change weight-of-evidence characterization for probability of causation based upon levels of available epidemiological and toxicological evidence for one or more chemicals contributing to disease by an endocrine disruptor mechanism. To evaluate the epidemiological evidence, the Steering Committee adapted the World Health Organization Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group criteria, whereas the Steering Committee adapted definitions recently promulgated by the Danish Environmental Protection Agency for evaluating laboratory and animal evidence of endocrine disruption. Expert panels used the Delphimethod tomake decisions on the strength of the data.Results: Expert panels achieved consensus for probable (20%) EDC causation for IQ loss and associated intellectual disability, autism, attention-deficit hyperactivity disorder, childhood obesity, adult obesity, adult diabetes, cryptorchidism, male infertility, and mortality associated with reduced T. Accounting for probability of causation and using the midpoint of each range for probability of causation, Monte Carlo simulations produced a median cost of €157 billion (1.23% of EU gross domestic product) annually across 1000 simulations.Notably,using thelowest endof theprobability range for each relationshipin theMonte Carlo simulations produced a median range of €119 billion that differed modestly from base case probability inputs. Conclusions: EDC exposures in the EU are likely to contribute substantially to disease and dysfunction across the life course with costs in the hundreds of billions per year. These estimates represent only those EDCs with the highest probability of causation; a broader analysis would have produced greater estimates of burden of disease and costs.