欧盟女性生殖系统疾病、病症及接触内分泌干扰化学物质的成本
Female Reproductive Disorders, Diseases, and Costs of Exposure to Endocrine Disrupting Chemicals in the European Union.
作者信息
Hunt Patricia A, Sathyanarayana Sheela, Fowler Paul A, Trasande Leonardo
机构信息
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.
出版信息
J Clin Endocrinol Metab. 2016 Apr;101(4):1562-70. doi: 10.1210/jc.2015-2873. Epub 2016 Mar 22.
CONTEXT
A growing body of evidence suggests that endocrine-disrupting chemicals (EDCs) contribute to female reproductive disorders.
OBJECTIVE
To calculate the associated combined health care and economic costs attributable to specific EDC exposures within the European Union (EU).
DESIGN
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.
SETTING, PATIENTS AND PARTICIPANTS AND INTERVENTION: Cost estimation was carried out from a societal perspective, ie, including direct costs (eg, treatment costs) and indirect costs such as productivity loss.
RESULTS
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.
CONCLUSIONS
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.
背景
越来越多的证据表明，内分泌干扰化学物质（EDCs）会导致女性生殖系统紊乱。
目的
计算欧盟内特定EDC暴露所致的相关综合医疗保健和经济成本。
设计
一个专家小组使用政府间气候变化专门委员会的证据权重法评估因果关系的可能性证据。评估了暴露-反应关系和参考水平，并从同行评审文献中精心挑选的研究中整理出生物标志物数据，以代表2010年欧洲的暴露情况和近似疾病负担。疾病成本估算使用了多个经过同行评审的来源。
地点、患者、参与者及干预措施：成本估算是从社会角度进行的，即包括直接成本（如治疗成本）和间接成本，如生产力损失。
结果
在欧洲，关于女性生殖系统紊乱，与EDC相关的最有力数据存在于1）二苯二氯乙烷所致的子宫肌瘤和2）邻苯二甲酸盐所致的子宫内膜异位症。在这两种情况下，流行病学证据的强度被评为低，毒理学证据为中等，因果关系的指定概率为20%-39%。在整个欧盟，估计分别有56700名和145000名女性患病，经济和医疗保健总成本可能分别达到1.63亿欧元和12.5亿欧元。
结论
EDCs（二苯二氯乙烷和邻苯二甲酸盐）可能在很大程度上导致了女性最常见的生殖系统紊乱，即子宫内膜异位症和子宫肌瘤，每年造成近15亿欧元的损失。这些估计仅代表有足够流行病学研究且因果关系概率最高的EDCs。在欧盟考虑对EDCs采取监管行动时，应考虑这些公共卫生成本。
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