Nedellec Vincent, Rabl Ari, Dab William
Director of Vincent Nedellec Conseil, 23, rue André Masséna-83000, Toulon, France.
Retired from Ecole des Mines/ARMINES, Paris, Consultant on Environmental Impacts, 6 av. Faidherbe, 91440, Bures sur Yvette, France.
Environ Health. 2016 Jul 19;15(1):78. doi: 10.1186/s12940-016-0159-3.
Inhabitants of Guadeloupe are chronically exposed to low doses of chlordecone via local food due to its past use in banana plantations. The corresponding health impacts have not been quantified. We develop a quantitative method and present the results in two articles: 1. Hazard identification, exposure-response functions, and exposure, 2. Health impacts, and benefits of a program to reduce the exposure of the population. Here is the second article.
The exposure-response functions derived in Part 1 (for liver and prostate cancer, renal dysfunction and cognitive development) are combined with the exposure data to calculate the impacts. The corresponding costs are calculated via DALY's and VOLY. A no-effect threshold is included via the marginal fraction of the collective exposure above the reference dose. The health benefits are the impacts in 2002 (before the exposure reduction program) minus the impacts in 2006 (since the program). They are compared to the costs, namely the public annual expenditures for reducing the population exposure.
Without threshold, estimated annual cases of liver cancer, prostate cancer and renal dysfunction are respectively 5.4, 2.8, 0.10 in 2002; and 2.0, 1.0, 0.04 in 2006. Annual IQ points lost (cognitive development) are respectively: 1 173 and 1 003. The annual cost of total impacts is 38.3 Million Euros (M€) in 2002 and 23.7 M€ in 2006. Comparing the benefit of 14.6 M€ with the 3.25 M€ spent for prevention, the program appears well justified. With threshold, the costs of the impacts are lower, respectively: 26.5 M€ in 2002 and 12.8 M€ in 2006, but the benefit is not very different: 13.7 M€.
This is the first study that quantified chronic non genotoxic effects of chlordecone exposures in Guadeloupe. According to our results, preventive actions should be focused on pregnant women because of the high social cost of development impairment and also because their exposures decreased less rapidly than others. Prevention effort should be sustained as long as chlordecone remains in soils. Additional toxicological and epidemiological research would also be required for health endpoints that could not be taken into account (neurotoxicity of adults, autoimmune diseases and other developmental effects).
由于过去在香蕉种植园中使用过开蓬，瓜德罗普岛居民长期通过当地食物接触低剂量的开蓬。相应的健康影响尚未量化。我们开发了一种定量方法，并在两篇文章中呈现结果：1. 危害识别、暴露 - 反应函数及暴露情况；2. 健康影响以及减少人群暴露项目的益处。以下是第二篇文章。
将第1部分得出的暴露 - 反应函数（针对肝癌、前列腺癌、肾功能障碍和认知发育）与暴露数据相结合以计算影响。通过伤残调整生命年（DALY）和伤残调整寿命损失年（VOLY）计算相应成本。通过集体暴露高于参考剂量的边际比例纳入无效应阈值。健康益处为2002年（减少暴露项目实施前）的影响减去2006年（项目实施后）的影响。将它们与成本进行比较，即减少人群暴露的公共年度支出。
无阈值时，2002年估计的肝癌、前列腺癌和肾功能障碍年病例数分别为5.4、2.8、0.10；2006年分别为2.0、1.0、0.04。每年损失的智商点数（认知发育）分别为1173和1003。2002年总影响的年度成本为3830万欧元（M€），2006年为2370万欧元。将1,460万欧元的益处与用于预防花费的325万欧元相比较，该项目似乎很有合理性。有阈值时，影响的成本较低，2002年分别为2650万欧元，2006年为1280万欧元，但益处差异不大：1370万欧元。
这是第一项量化瓜德罗普岛开蓬暴露慢性非遗传毒性影响的研究。根据我们的结果，预防行动应聚焦于孕妇，这是因为发育受损的社会成本高昂，还因为她们的暴露下降速度比其他人慢。只要土壤中仍有开蓬，预防工作就应持续。对于无法考虑的健康终点（成人神经毒性、自身免疫性疾病和其他发育影响），还需要额外的毒理学和流行病学研究。
