Limits...
Knowns and unknowns on burden of disease due to chemicals: a systematic review.

Prüss-Ustün A, Vickers C, Haefliger P, Bertollini R - Environ Health (2011)

Bottom Line: These are followed by occupational particulates, chemicals involved in acute poisonings, and pesticides involved in self-poisonings, with 375,000, 240,000 and 186,000 annual deaths, respectively.The known burden due to chemicals is considerable.These figures present only a number of chemicals for which data are available, therefore, they are more likely an underestimate of the actual burden.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health and Environment, World Health Organization, av. Appia 20, 1211 Geneva 27, Geneva, Switzerland. pruessa@who.int

ABSTRACT

Background: Continuous exposure to many chemicals, including through air, water, food, or other media and products results in health impacts which have been well assessed, however little is known about the total disease burden related to chemicals. This is important to know for overall policy actions and priorities. In this article the known burden related to selected chemicals or their mixtures, main data gaps, and the link to public health policy are reviewed.

Methods: A systematic review of the literature for global burden of disease estimates from chemicals was conducted. Global disease due to chemicals was estimated using standard methodology of the Global Burden of Disease.

Results: In total, 4.9 million deaths (8.3% of total) and 86 million Disability-Adjusted Life Years (DALYs) (5.7% of total) were attributable to environmental exposure and management of selected chemicals in 2004. The largest contributors include indoor smoke from solid fuel use, outdoor air pollution and second-hand smoke, with 2.0, 1.2 and 0.6 million deaths annually. These are followed by occupational particulates, chemicals involved in acute poisonings, and pesticides involved in self-poisonings, with 375,000, 240,000 and 186,000 annual deaths, respectively.

Conclusions: The known burden due to chemicals is considerable. This information supports decision-making in programmes having a role to play in reducing human exposure to toxic chemicals. These figures present only a number of chemicals for which data are available, therefore, they are more likely an underestimate of the actual burden. Chemicals with known health effects, such as dioxins, cadmium, mercury or chronic exposure to pesticides could not be included in this article due to incomplete data and information. Effective public health interventions are known to manage chemicals and limit their public health impacts and should be implemented at national and international levels.

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Occurrence and detection of health impacts from chemicals Adapted from [64,65]
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Figure 3: Occurrence and detection of health impacts from chemicals Adapted from [64,65]

Mentions: While certain outcomes, such as those resulting from acute poisonings or high-level exposures, may easily be traced back to chemicals, other delayed or sub-clinical health effects such as cancers or certain neurological diseases are much more difficult to allocate to specific exposures (Figure 3). This is particularly true for diseases with long lag-times from exposures, complex exposure assessment, and often non-specific health outcomes. Also current toxicological test systems have limitations in their ability to predict effects in humans. Figure 2 schematically represents the possible fraction of the true burden of disease from chemical exposure that has effectively been traced back with sufficient scientific evidence to chemicals. It highlights that acute poisonings, outcomes caused by high-level exposures and rare health effects in more controlled occupational environments are often easier to trace back to chemicals than health effects resulting from the more frequent but lower-level exposures.


Knowns and unknowns on burden of disease due to chemicals: a systematic review.

Prüss-Ustün A, Vickers C, Haefliger P, Bertollini R - Environ Health (2011)

Occurrence and detection of health impacts from chemicals Adapted from [64,65]
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3037292&req=5

Figure 3: Occurrence and detection of health impacts from chemicals Adapted from [64,65]
Mentions: While certain outcomes, such as those resulting from acute poisonings or high-level exposures, may easily be traced back to chemicals, other delayed or sub-clinical health effects such as cancers or certain neurological diseases are much more difficult to allocate to specific exposures (Figure 3). This is particularly true for diseases with long lag-times from exposures, complex exposure assessment, and often non-specific health outcomes. Also current toxicological test systems have limitations in their ability to predict effects in humans. Figure 2 schematically represents the possible fraction of the true burden of disease from chemical exposure that has effectively been traced back with sufficient scientific evidence to chemicals. It highlights that acute poisonings, outcomes caused by high-level exposures and rare health effects in more controlled occupational environments are often easier to trace back to chemicals than health effects resulting from the more frequent but lower-level exposures.

Bottom Line: These are followed by occupational particulates, chemicals involved in acute poisonings, and pesticides involved in self-poisonings, with 375,000, 240,000 and 186,000 annual deaths, respectively.The known burden due to chemicals is considerable.These figures present only a number of chemicals for which data are available, therefore, they are more likely an underestimate of the actual burden.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Public Health and Environment, World Health Organization, av. Appia 20, 1211 Geneva 27, Geneva, Switzerland. pruessa@who.int

ABSTRACT

Background: Continuous exposure to many chemicals, including through air, water, food, or other media and products results in health impacts which have been well assessed, however little is known about the total disease burden related to chemicals. This is important to know for overall policy actions and priorities. In this article the known burden related to selected chemicals or their mixtures, main data gaps, and the link to public health policy are reviewed.

Methods: A systematic review of the literature for global burden of disease estimates from chemicals was conducted. Global disease due to chemicals was estimated using standard methodology of the Global Burden of Disease.

Results: In total, 4.9 million deaths (8.3% of total) and 86 million Disability-Adjusted Life Years (DALYs) (5.7% of total) were attributable to environmental exposure and management of selected chemicals in 2004. The largest contributors include indoor smoke from solid fuel use, outdoor air pollution and second-hand smoke, with 2.0, 1.2 and 0.6 million deaths annually. These are followed by occupational particulates, chemicals involved in acute poisonings, and pesticides involved in self-poisonings, with 375,000, 240,000 and 186,000 annual deaths, respectively.

Conclusions: The known burden due to chemicals is considerable. This information supports decision-making in programmes having a role to play in reducing human exposure to toxic chemicals. These figures present only a number of chemicals for which data are available, therefore, they are more likely an underestimate of the actual burden. Chemicals with known health effects, such as dioxins, cadmium, mercury or chronic exposure to pesticides could not be included in this article due to incomplete data and information. Effective public health interventions are known to manage chemicals and limit their public health impacts and should be implemented at national and international levels.

Show MeSH
Related in: MedlinePlus