Nelson Lauren, Valle Jhaqueline, King Galatea, Mills Paul K, Richardson Maxwell J, Roberts Eric M, Smith Daniel, English Paul
Lauren Nelson is with the California Epidemiologic Investigation Service Fellowship Program, California Department of Public Health, Richmond. Jhaqueline Valle, Galatea King, Maxwell J. Richardson, and Eric M. Roberts are with the California Environmental Health Tracking Program, Richmond. Paul K. Mills is with the Fresno Medical Education and Research Program, University of California San Francisco, Fresno. Daniel Smith and Paul English are with the California Department of Public Health, Richmond.
Am J Public Health. 2017 May;107(5):756-762. doi: 10.2105/AJPH.2017.303690. Epub 2017 Mar 21.
To estimate the proportion of cases and costs of the most common cancers among children aged 0 to 14 years (leukemia, lymphoma, and brain or central nervous system tumors) that were attributable to preventable environmental pollution in California in 2013.
We conducted a literature review to identify preventable environmental hazards associated with childhood cancer. We combined risk estimates with California-specific exposure prevalence estimates to calculate hazard-specific environmental attributable fractions (EAFs). We combined hazard-specific EAFs to estimate EAFs for each cancer and calculated an overall EAF. Estimated economic costs included annual (indirect and direct medical) and lifetime costs.
Hazards associated with childhood cancer risks included tobacco smoke, residential exposures, and parental occupational exposures. Estimated EAFs for leukemia, lymphoma, and brain or central nervous system cancer were 21.3% (range = 11.7%-30.9%), 16.1% (range = 15.0%-17.2%), and 2.0% (range = 1.7%-2.2%), respectively. The combined EAF was 15.1% (range = 9.4%-20.7%), representing $18.6 million (range = $11.6 to $25.5 million) in annual costs and $31 million in lifetime costs.
Reducing environmental hazards and exposures in California could substantially reduce the human burden of childhood cancer and result in significant annual and lifetime savings.
估算2013年加利福尼亚州0至14岁儿童中最常见癌症（白血病、淋巴瘤以及脑或中枢神经系统肿瘤）的病例比例和成本，这些癌症可归因于可预防的环境污染。
我们进行了文献综述，以确定与儿童癌症相关的可预防环境危害。我们将风险估计与加利福尼亚州特定的暴露患病率估计相结合，以计算特定危害的环境归因分数（EAFs）。我们将特定危害的EAFs相结合，以估计每种癌症的EAFs，并计算总体EAF。估计的经济成本包括年度（间接和直接医疗）成本和终身成本。
与儿童癌症风险相关的危害包括烟草烟雾、家庭暴露和父母职业暴露。白血病、淋巴瘤以及脑或中枢神经系统癌症的估计EAFs分别为21.3%（范围=11.7%-30.9%）、16.1%（范围=15.0%-17.2%）和2.0%（范围=1.7%-2.2%）。综合EAF为15.1%（范围=9.4%-20.7%），代表年度成本为1860万美元（范围=1160万至2550万美元），终身成本为3100万美元。
减少加利福尼亚州的环境危害和暴露可大幅减轻儿童癌症的人类负担，并在年度和终身成本方面带来显著节省。
