Flemish Institute for Technological Research (VITO), Boeretang 200, Mol, 2400, Belgium.
Technical University of Denmark, DTU, Henrik Dams Allé, 201, Kgs. Lyngby, 2800, Denmark.
Environ Health. 2024 Oct 23;23(1):91. doi: 10.1186/s12940-024-01131-w.
Human biomonitoring (HBM) data indicate that exposure to pyrethroids is widespread in Europe, with significantly higher exposure observed in children compared to adults. Epidemiological, toxicological, and mechanistic studies raise concerns for potential human health effects, particularly, behavioral effects such as attention deficit hyperactivity disorder (ADHD) in children at low levels of exposure. Based on an exposure-response function from a single European study and on available quality-assured and harmonized HBM data collected in France, Germany, Iceland, Switzerland, and Israel, a preliminary estimate of the environmental burden of disease for ADHD associated with pyrethroid exposure was made for individuals aged 0-19 years. The estimated annual number of prevalence-based disability-adjusted life years (DALYs) per million inhabitants were 27 DALYs for Israel, 21 DALYs for France, 12 DALYs for both Switzerland and Iceland, and 3 DALYs for Germany; while the annual ADHD cases per million inhabitants attributable to pyrethroids were 2189 for Israel, 1710 for France, 969 for Iceland, 944 for Switzerland, and 209 for Germany. Direct health costs related to ADHD ranged between 0.3 and 2.5 million EUR yearly per million inhabitants for the five countries. Additionally, a substantial number of ADHD cases, on average 18%, were associated with pyrethroid exposure. Yet, these figures should be interpreted with caution given the uncertainty of the estimation. A sensitivity analysis showed that by applying a different exposure-response function from outside the EU, the population attributable fraction decreased from an average of 18 to 7%. To ensure more robust disease burden estimates and adequate follow-up of policy measures, more HBM studies are needed, along with increased efforts to harmonize the design of epidemiological studies upfront to guarantee meta-analysis of exposure-response functions. This is particularly important for pyrethroids as evidence of potential adverse health effects is continuously emerging.
人体生物监测 (HBM) 数据表明，拟除虫菊酯在欧洲的暴露较为普遍，儿童的暴露水平明显高于成人。流行病学、毒理学和机制研究引起了人们对潜在人类健康影响的关注，特别是儿童在低暴露水平下的注意力缺陷多动障碍 (ADHD) 等行为影响。基于来自一项欧洲研究的暴露-反应函数以及在法国、德国、冰岛、瑞士和以色列收集的可用、经过质量保证和协调一致的 HBM 数据，对与拟除虫菊酯暴露相关的 ADHD 的疾病环境负担进行了初步估计，研究对象为 0-19 岁人群。以每百万居民为单位，估计每年基于流行率的伤残调整生命年 (DALY) 数量为：以色列 27 DALY，法国 21 DALY，瑞士和冰岛各 12 DALY，德国 3 DALY；而每年归因于拟除虫菊酯的每百万居民 ADHD 病例数为：以色列 2189 例，法国 1710 例，冰岛 969 例，瑞士 944 例，德国 209 例。与 ADHD 相关的直接卫生费用在这五个国家每年为每百万居民 0.3 至 2.5 百万欧元。此外，平均有 18%的 ADHD 病例与拟除虫菊酯暴露有关。然而，考虑到估计的不确定性，这些数字应该谨慎解读。敏感性分析表明，应用欧盟以外的不同暴露-反应函数，人群归因分数从平均 18%降至 7%。为了确保更稳健的疾病负担估计和对政策措施的充分跟踪，需要开展更多的 HBM 研究，并加大力度协调流行病学研究的设计，以保证对暴露-反应函数进行荟萃分析。这对于拟除虫菊酯尤其重要，因为不断有潜在不良健康影响的证据出现。
