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1.
BMJ ; 367: l6258, 2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-31776122

RESUMO

OBJECTIVE: To assess risks and costs of hospital admission associated with short term exposure to fine particulate matter with diameter less than 2.5 µm (PM2.5) for 214 mutually exclusive disease groups. DESIGN: Time stratified, case crossover analyses with conditional logistic regressions adjusted for non-linear confounding effects of meteorological variables. SETTING: Medicare inpatient hospital claims in the United States, 2000-12 (n=95 277 169). PARTICIPANTS: All Medicare fee-for-service beneficiaries aged 65 or older admitted to hospital. MAIN OUTCOME MEASURES: Risk of hospital admission, number of admissions, days in hospital, inpatient and post-acute care costs, and value of statistical life (that is, the economic value used to measure the cost of avoiding a death) due to the lives lost at discharge for 214 disease groups. RESULTS: Positive associations between short term exposure to PM2.5 and risk of hospital admission were found for several prevalent but rarely studied diseases, such as septicemia, fluid and electrolyte disorders, and acute and unspecified renal failure. Positive associations were also found between risk of hospital admission and cardiovascular and respiratory diseases, Parkinson's disease, diabetes, phlebitis, thrombophlebitis, and thromboembolism, confirming previously published results. These associations remained consistent when restricted to days with a daily PM2.5 concentration below the WHO air quality guideline for the 24 hour average exposure to PM2.5. For the rarely studied diseases, each 1 µg/m3 increase in short term PM2.5 was associated with an annual increase of 2050 hospital admissions (95% confidence interval 1914 to 2187 admissions), 12 216 days in hospital (11 358 to 13 075), US$31m (£24m, €28m; $29m to $34m) in inpatient and post-acute care costs, and $2.5bn ($2.0bn to $2.9bn) in value of statistical life. For diseases with a previously known association, each 1 µg/m3 increase in short term exposure to PM2.5 was associated with an annual increase of 3642 hospital admissions (3434 to 3851), 20 098 days in hospital (18 950 to 21 247), $69m ($65m to $73m) in inpatient and post-acute care costs, and $4.1bn ($3.5bn to $4.7bn) in value of statistical life. CONCLUSIONS: New causes and previously identified causes of hospital admission associated with short term exposure to PM2.5 were found. These associations remained even at a daily PM2.5 concentration below the WHO 24 hour guideline. Substantial economic costs were linked to a small increase in short term PM2.5.


Assuntos
Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Hospitalização/estatística & dados numéricos , Material Particulado/análise , Idoso , Poluentes Atmosféricos/economia , Poluição do Ar/economia , Custos e Análise de Custo , Estudos Cross-Over , Exposição Ambiental/economia , Feminino , Hospitalização/economia , Humanos , Masculino , Medicare , Pessoa de Meia-Idade , Material Particulado/economia , Fatores de Risco , Fatores de Tempo , Estados Unidos
3.
Int J Tuberc Lung Dis ; 23(4): 412-421, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-31064619

RESUMO

OBJECTIVES To examine: 1) whether exposure to secondhand smoke (SHS) at home is associated with symptoms of self-reported illness among mother-child pairs (MCPs); and 2) the relationship between low socio-economic status and SHS exposure and the role these play as obstacles to the reduction of risk of illness in MCPs. METHOD A cross-sectional study was conducted in Rajshahi District, Bangladesh, from May to July 2017. A total of 541 MCPs were interviewed. RESULTS The prevalence of SHS exposure at home in our sample data was 49.0%. SHS exposure was found to be associated with a higher likelihood of any self-reported rhinitis, any respiratory symptoms and any reproductive health problems among mothers. SHS exposure in children was found to be associated with a higher likelihood of any self-reported rhinitis and food sensitisation, any respiratory symptoms and otitis media. Our findings also suggested that although SHS had an independently adverse effect on MCPs, wealth moderated the likelihood of illness. CONCLUSIONS MCPs who were both poor and exposed to SHS were uniquely disadvantaged in terms of their poor health conditions than MCPs who were wealthier and exposed to SHS. .


Assuntos
Exposição Ambiental/efeitos adversos , Pobreza/estatística & dados numéricos , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Adulto , Bangladesh/epidemiologia , Pré-Escolar , Estudos Transversais , Exposição Ambiental/economia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Prevalência , Fatores de Risco , Autorrelato , Fatores Socioeconômicos , Poluição por Fumaça de Tabaco/economia , Adulto Jovem
4.
Proc Natl Acad Sci U S A ; 116(12): 5246-5253, 2019 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-30478054

RESUMO

Asthma ranks among the most costly of chronic diseases, accounting for over $50 billion annually in direct medical expenditures in the United States. At the same time, evidence has accumulated that fine particulate matter pollution can exacerbate asthma symptoms and generate substantial economic costs. To measure these costs, we use a unique nationwide panel dataset tracking asthmatic individuals' use of rescue medication and their exposure to PM2.5 (particulate matter with an aerodynamic diameter of <2.5 µm) concentration between 2012 and 2017, to estimate the causal relationship between pollution and inhaler use. Our sample consists of individuals using an asthma digital health platform, which relies on a wireless sensor to track the place and time of inhaler use events, as well as regular nonevent location and time indicators. These data provide an accurate measurement of inhaler use and allow spatially and temporally resolute assignment of pollution exposure. Using a high-frequency research design and individual fixed effects, we find that a 1 µg/m3 (12%) increase in weekly exposure to PM2.5 increases weekly inhaler use by 0.82%. We also show that there is seasonal, regional, and income-based heterogeneity in this response. Using our response prediction, and an estimate from the literature on the willingness to pay to avoid asthma symptoms, we show that a nationwide 1 µg/m3 reduction in particulate matter concentration would generate nearly $350 million annually in economic benefits.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Poluição do Ar/efeitos adversos , Poluição do Ar/economia , Asma/economia , Asma/prevenção & controle , Material Particulado/efeitos adversos , Exposição Ambiental/efeitos adversos , Exposição Ambiental/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Estados Unidos
5.
Sci Total Environ ; 655: 454-462, 2019 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-30472647

RESUMO

Severe air pollution problems have led to a rise in the Chinese public's concern. Risk perception is one of the most important indicators of the public's concern about air pollution. However, there existed few studies exploring the spatial distribution of risk perception. To fill the gap, psychometric paradigm methods was adopted to assess the public's risk perception of air pollution. A nationwide empirical study was conducted from December 2016 to February 2017 and 10,653 completed questionnaires were collected. According to a series of screening strategies, 9744 qualified questionnaires were included as a sample, which covered 31 China provinces (Hong Kong, Macao and Taiwan were not included in this study). We found that 45% of the respondents were dissatisfied with the current air quality, many respondents concerned a lot about air pollution (76%) and worried about the harmful consequences of being exposed to air pollution (86%). There was significant difference in the public's risk perception and attitude toward air pollution among different regions: the respondents in the northeast region, northern coastal region, eastern coastal region and Middle Yellow river region perceived higher air pollution risk and lower satisfaction with air quality than other regions; and the public's trust in the government increased from coastal regions to inland regions. In addition, the hierarchical linear model (HLM) was used to explore the effects of demographic, environmental and economic factors on public risk perception and attitude toward air pollution. Based on this, the characteristics of sensitive populations regarding air pollution were identified. What's more, we found that PM2.5 has a positive influence on perceived risk factor (PR) and can strengthen the positive correlation between PR and satisfaction with air quality (SAQ). Finally, policy implications behind these results were discussed, which can provide references and lay the foundation for policymakers and subsequent researchers.


Assuntos
Poluição do Ar/prevenção & controle , Atitude , Conservação dos Recursos Naturais , Exposição Ambiental/efeitos adversos , Política Ambiental , Percepção , China , Desenvolvimento Econômico/tendências , Exposição Ambiental/economia , Política Ambiental/economia , Humanos , Modelos Lineares , Psicometria , Fatores de Risco , Análise Espacial , Inquéritos e Questionários
6.
Artigo em Inglês | MEDLINE | ID: mdl-30356019

RESUMO

Lead exposure is a legacy issue that continues to affect vulnerable population groups globally, but particularly in low and middle-income countries (LMICS). We take a multi-disciplinary approach to examine the patterns of lead exposure in these countries, discuss the underlying injustices and socio-political causes, and the economic costs that are associated with exposure. We conclude with some lessons we drew from our discussion of lead across the disciplines and advocate for a number of approaches to solving this ongoing issue. These include (i) biomonitoring that could be integrated into existing health surveys or public health programs targeting young children; (ii) greater civic engagement to push for solutions; and, (iii) environmental control policies that represent a continuum of local, context-specific to broad, national-level, and even global approaches.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Exposição Ambiental , Intoxicação por Chumbo/epidemiologia , Chumbo/toxicidade , Política , Pobreza , Criança , Exposição Ambiental/economia , Exposição Ambiental/estatística & dados numéricos , Humanos , Renda , Fatores Socioeconômicos
7.
Artigo em Inglês | MEDLINE | ID: mdl-30235898

RESUMO

Analyzing the association between fine particulate matter (PM2.5) pollution and socio-economic factors has become a major concern in public health. Since traditional analysis methods (such as correlation analysis and geographically weighted regression) cannot provide a full assessment of this relationship, the quantile regression method was applied to overcome such a limitation at different spatial scales in this study. The results indicated that merely 3% of the population and 2% of the Gross Domestic Product (GDP) occurred under an annually mean value of 35 µg/m³ in mainland China, and the highest population exposure to PM2.5 was located in a lesser-known city named Dazhou in 2014. The analysis results at three spatial scales (grid-level, county-level, and city-level) demonstrated that the grid-level was the optimal spatial scale for analysis of socio-economic effects on exposure due to its tiny uncertainty, and the population exposure to PM2.5 was positively related to GDP. An apparent upward trend of population exposure to PM2.5 emerged at the 80th percentile GDP. For a 10 thousand yuan rise in GDP, population exposure to PM2.5 increases by 1.05 person/km² at the 80th percentile, and 1.88 person/km2 at the 95th percentile, respectively.


Assuntos
Poluição do Ar/estatística & dados numéricos , Exposição Ambiental/economia , Produto Interno Bruto , Material Particulado/economia , Regressão Espacial , Poluentes Atmosféricos , China , Cidades , Humanos , Saúde Pública , Análise de Regressão , Fatores Socioeconômicos , Incerteza
8.
Proc Natl Acad Sci U S A ; 115(37): 9193-9197, 2018 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-30150383

RESUMO

This paper examines the effect of both cumulative and transitory exposures to air pollution for the same individuals over time on cognitive performance by matching a nationally representative longitudinal survey and air quality data in China according to the exact time and geographic locations of the cognitive tests. We find that long-term exposure to air pollution impedes cognitive performance in verbal and math tests. We provide evidence that the effect of air pollution on verbal tests becomes more pronounced as people age, especially for men and the less educated. The damage on the aging brain by air pollution likely imposes substantial health and economic costs, considering that cognitive functioning is critical for the elderly for both running daily errands and making high-stake decisions.


Assuntos
Poluição do Ar , Cognição , Exposição Ambiental , Modelos Econométricos , Poluição do Ar/efeitos adversos , Poluição do Ar/economia , China , Exposição Ambiental/efeitos adversos , Exposição Ambiental/economia , Humanos
9.
Artigo em Inglês | MEDLINE | ID: mdl-29710784

RESUMO

There is growing recognition that implementation of low-carbon policies in urban passenger transport has near-term health co-benefits through increased physical activity and improved air quality. Nevertheless, co-benefits and related cost reductions are often not taken into account in decision processes, likely because they are not easy to capture. In an interdisciplinary multi-model approach we address this gap, investigating the co-benefits resulting from increased physical activity and improved air quality due to climate mitigation policies for three urban areas. Additionally we take a (macro-)economic perspective, since that is the ultimate interest of policy-makers. Methodologically, we link a transport modelling tool, a transport emission model, an emission dispersion model, a health model and a macroeconomic Computable General Equilibrium (CGE) model to analyze three climate change mitigation scenarios. We show that higher levels of physical exercise and reduced exposure to pollutants due to mitigation measures substantially decrease morbidity and mortality. Expenditures are mainly born by the public sector but are mostly offset by the emerging co-benefits. Our macroeconomic results indicate a strong positive welfare effect, yet with slightly negative GDP and employment effects. We conclude that considering economic co-benefits of climate change mitigation policies in urban mobility can be put forward as a forceful argument for policy makers to take action.


Assuntos
Poluição do Ar/prevenção & controle , Mudança Climática , Exposição Ambiental/prevenção & controle , Política Ambiental , Exercício , Saúde da População Urbana , Emissões de Veículos/prevenção & controle , Poluentes Atmosféricos , Poluição do Ar/economia , Áustria , Análise Custo-Benefício , Exposição Ambiental/economia , Política Ambiental/economia , Política de Saúde , Promoção da Saúde/economia , Promoção da Saúde/métodos , Humanos , Modelos Teóricos , Transportes/economia , Transportes/métodos
10.
Artigo em Inglês | MEDLINE | ID: mdl-29649153

RESUMO

Air pollution has been estimated to be one of the leading environmental health risks in Finland. National health impact estimates existing to date have focused on particles (PM) and ozone (O3). In this work, we quantify the impacts of particles, ozone, and nitrogen dioxide (NO2) in 2015, and analyze the related uncertainties. The exposures were estimated with a high spatial resolution chemical transport model, and adjusted to observed concentrations. We calculated the health impacts according to Word Health Organization (WHO) working group recommendations. According to our results, ambient air pollution caused a burden of 34,800 disability-adjusted life years (DALY). Fine particles were the main contributor (74%) to the disease burden, which is in line with the earlier studies. The attributable burden was dominated by mortality (32,900 years of life lost (YLL); 95%). Impacts differed between population age groups. The burden was clearly higher in the adult population over 30 years (98%), due to the dominant role of mortality impacts. Uncertainties due to the concentration-response functions were larger than those related to exposures.


Assuntos
Poluentes Atmosféricos/economia , Poluição do Ar/economia , Dióxido de Nitrogênio/economia , Ozônio/economia , Material Particulado/economia , Adulto , Poluentes Atmosféricos/análise , Poluição do Ar/análise , Exposição Ambiental/análise , Exposição Ambiental/economia , Finlândia/epidemiologia , Humanos , Modelos Químicos , Dióxido de Nitrogênio/análise , Ozônio/análise , Material Particulado/análise , Anos de Vida Ajustados por Qualidade de Vida , Risco , Análise Espacial
11.
Cancer Epidemiol Biomarkers Prev ; 27(5): 601-609, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29511038

RESUMO

Background: Increased cigarette costs have inadvertently strengthened the appeal of discounted brands to price-sensitive smokers. Although smokers perceive discounted brands as having poorer quality, little is known about their delivery of toxic tobacco smoke constituents compared with premium-branded tobacco products.Methods: We investigated the differences between discount and premium brand smokers using the National Health and Nutrition Examination Survey 2011-2012 Special Smoker Sample. Our analyses focused on demographic differences and 27 biomarkers of harmful and potentially harmful constituents (HPHC) listed by the FDA, including volatile organic compounds, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronide [4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol glucuronide; reported as total NNAL (tNNAL)], metals, and polycyclic aromatic hydrocarbons (PAHs). Data were analyzed using linear regression models adjusting for potential confounders.Results: A total of 976 non-tobacco users and 578 recent cigarette smokers were eligible for analysis, of which 141 (26.0% weighted) smoked discount brand cigarettes and 437 (74.0% weighted) smoked premium. Discount brand smokers were older, predominantly non-Hispanic white, and had higher serum cotinine. Discount brand smokers had significantly higher levels of 13 smoking-related biomarkers, including tNNAL, uranium, styrene, xylene, and biomarkers of exposure to PAHs (naphthalene, fluorene, and phenanthrene), compared with premium brand smokers.Conclusions: These findings suggest that discount cigarette use is associated with higher exposure to several carcinogenic and toxic HPHCs.Impact: These results may have important regulatory implications for product standards, as higher exposures could lead to a greater degree of harm. Cancer Epidemiol Biomarkers Prev; 27(5); 601-9. ©2018 AACR.


Assuntos
Carcinógenos/análise , Exposição Ambiental/estatística & dados numéricos , Fumar/efeitos adversos , Produtos do Tabaco/toxicidade , Adulto , Fatores Etários , Biomarcadores/sangue , Biomarcadores/urina , Carcinógenos/toxicidade , Exposição Ambiental/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumar/sangue , Fumar/economia , Fumar/urina , Produtos do Tabaco/economia , Estados Unidos
12.
Artigo em Inglês | MEDLINE | ID: mdl-29596347

RESUMO

BACKGROUND: Urban outdoor air pollution, especially particulate matter, remains a major environmental health problem in Skopje, the capital of the former Yugoslav Republic of Macedonia. Despite the documented high levels of pollution in the city, the published evidence on its health impacts is as yet scarce. METHODS: we obtained, cleaned, and validated Particulate Matter (PM) concentration data from five air quality monitoring stations in the Skopje metropolitan area, applied relevant concentration-response functions, and evaluated health impacts against two theoretical policy scenarios. We then calculated the burden of disease attributable to PM and calculated the societal cost due to attributable mortality. RESULTS: In 2012, long-term exposure to PM2.5 (49.2 µg/m³) caused an estimated 1199 premature deaths (CI95% 821-1519). The social cost of the predicted premature mortality in 2012 due to air pollution was estimated at between 570 and 1470 million euros. Moreover, PM2.5 was also estimated to be responsible for 547 hospital admissions (CI95% 104-977) from cardiovascular diseases, and 937 admissions (CI95% 937-1869) for respiratory disease that year. Reducing PM2.5 levels to the EU limit (25 µg/m³) could have averted an estimated 45% of PM-attributable mortality, while achieving the WHO Air Quality Guidelines (10 µg/m³) could have averted an estimated 77% of PM-attributable mortality. Both scenarios would also attain significant reductions in attributable respiratory and cardiovascular hospital admissions. CONCLUSIONS: Besides its health impacts in terms of increased premature mortality and hospitalizations, air pollution entails significant economic costs to the population of Skopje. Reductions in PM2.5 concentrations could provide substantial health and economic gains to the city.


Assuntos
Poluição do Ar/efeitos adversos , Poluição do Ar/economia , Exposição Ambiental/economia , Nível de Saúde , Hospitalização/economia , Mortalidade Prematura , Material Particulado/economia , Poluição do Ar/análise , Doenças Cardiovasculares/mortalidade , Cidades , Exposição Ambiental/efeitos adversos , Hospitalização/estatística & dados numéricos , Humanos , Material Particulado/efeitos adversos , Material Particulado/análise , Doenças Respiratórias/mortalidade , Medição de Risco
13.
Artigo em Inglês | MEDLINE | ID: mdl-29495633

RESUMO

The evidence concerning the acute effects of ambient air pollution on various respiratory diseases was limited in China, and the attributable medical expenditures were largely unknown. From 2013 to 2015, we collected data on the daily visits to the emergency- and outpatient-department for five main respiratory diseases and their medical expenditures in Shanghai, China. We used the overdispersed generalized additive model together with distributed lag models to fit the associations of criteria air pollutants with hospital visits, and used the linear models to fit the associations with medical expenditures. Generally, we observed significant increments in emergency visits (8.81-17.26%) and corresponding expenditures (0.33-25.81%) for pediatric respiratory diseases, upper respiratory infection (URI), and chronic obstructive pulmonary disease (COPD) for an interquartile range increase of air pollutant concentrations over four lag days. As a comparison, there were significant but smaller increments in outpatient visits (1.36-4.52%) and expenditures (1.38-3.18%) for pediatric respiratory diseases and upper respiratory infection (URI). No meaningful changes were observed for asthma and lower respiratory infection. Our study suggested that short-term exposure to outdoor air pollution may induce the occurrences or exacerbation of pediatric respiratory diseases, URI, and COPD, leading to considerable medical expenditures upon the patients.


Assuntos
Poluição do Ar/efeitos adversos , Exposição Ambiental/efeitos adversos , Gastos em Saúde/estatística & dados numéricos , Transtornos Respiratórios/etiologia , Poluição do Ar/análise , Poluição do Ar/economia , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Criança , China , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exposição Ambiental/análise , Exposição Ambiental/economia , Humanos , Masculino , Transtornos Respiratórios/economia , Transtornos Respiratórios/terapia , Estações do Ano
14.
Environ Health ; 16(1): 123, 2017 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-29202828

RESUMO

Calculation of costs and the Burden of Disease (BoD) is useful in developing resource allocation and prioritization strategies in public and environmental health. While useful, the Disability-Adjusted Life Year (DALY) metric disregards subclinical dysfunctions, adheres to stringent causal criteria, and is hampered by gaps in environmental exposure data, especially from industrializing countries. For these reasons, a recently calculated environmental BoD of 5.18% of the total DALYs is likely underestimated. We combined and extended cost calculations for exposures to environmental chemicals, including neurotoxicants, air pollution, and endocrine disrupting chemicals, where sufficient data were available to determine dose-dependent adverse effects. Environmental exposure information allowed cost estimates for the U.S. and the EU, for OECD countries, though less comprehensive for industrializing countries. As a complement to these health economic estimations, we used attributable risk valuations from expert elicitations to as a third approach to assessing the environmental BoD. For comparison of the different estimates, we used country-specific monetary values of each DALY. The main limitation of DALY calculations is that they are available for few environmental chemicals and primarily based on mortality and impact and duration of clinical morbidity, while less serious conditions are mostly disregarded. Our economic estimates based on available exposure information and dose-response data on environmental risk factors need to be seen in conjunction with other assessments of the total cost for these environmental risk factors, as our estimate overlaps only slightly with the previously estimated environmental DALY costs and crude calculations relying on attributable risks for environmental risk factors. The three approaches complement one another and suggest that environmental chemical exposures contribute costs that may exceed 10% of the global domestic product and that current DALY calculations substantially underestimate the economic costs associated with preventable environmental risk factors. By including toxicological and epidemiological information and data on exposure distributions, more representative results can be obtained from utilizing health economic analyses of the adverse effects associated with environmental chemicals.


Assuntos
Exposição Ambiental/efeitos adversos , Saúde Ambiental/economia , Poluentes Ambientais/toxicidade , Poluição do Ar/efeitos adversos , Efeitos Psicossociais da Doença , Disruptores Endócrinos/toxicidade , Exposição Ambiental/economia , Poluentes Ambientais/economia , Humanos
15.
Adv Exp Med Biol ; 1017: 233-242, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29177965

RESUMO

As the largest developing country in the world, China is now facing one of the severest air pollution problems. The objective of this section is to evaluate the disease burden and corresponding economic loss attributable to ambient air pollution in China. We reviewed a series of studies by Chinese or foreign investigators focusing on the disease burden and economic loss in China. These studies showed both the general air pollution and haze episodes have resulted in substantial disease burden in terms of excess number of premature deaths, disability-adjusted life-year loss, and years of life lost. The corresponding economic loss has accounted for an appreciable proportion of China's national economy. Overall, the disease burden and health economic loss due to ambient air pollution in China is greater than in the remaining parts of the world, for one of the highest levels of air pollution and the largest size of exposed population. Consideration of both health and economic impacts of air pollution can facilitate the Chinese government to develop environmental policies to reduce the emissions of various air pollutants and protect the public health.


Assuntos
Absenteísmo , Poluentes Atmosféricos/economia , Poluição do Ar/economia , Efeitos Psicossociais da Doença , Exposição Ambiental/economia , Seguro por Invalidez/economia , Material Particulado/economia , Saúde Pública/economia , Licença Médica/economia , Poluentes Atmosféricos/efeitos adversos , Poluentes Atmosféricos/análise , Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Causas de Morte , China , Exposição Ambiental/efeitos adversos , Monitoramento Ambiental/métodos , Nível de Saúde , Humanos , Expectativa de Vida , Modelos Econômicos , Material Particulado/efeitos adversos , Material Particulado/análise , Anos de Vida Ajustados por Qualidade de Vida , Medição de Risco
16.
Environ Manage ; 60(5): 809-822, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28905098

RESUMO

Recent growth in the frequency and severity of US wildfires has led to more wildfire smoke and increased public exposure to harmful air pollutants. Populations exposed to wildfire smoke experience a variety of negative health impacts, imposing economic costs on society. However, few estimates of smoke health costs exist and none for the entire Western US, in particular, which experiences some of the largest and most intense wildfires in the US. The lack of cost estimates is troublesome because smoke health impacts are an important consideration of the overall costs of wildfire. To address this gap, this study provides the first time series estimates of PM2.5 smoke costs across mortality and several morbidity measures for the Western US over 2005-2015. This time period includes smoke from several megafires and includes years of record-breaking acres burned. Smoke costs are estimated using a benefits transfer protocol developed for contexts when original health data are not available. The novelty of our protocol is that it synthesizes the literature on choices faced by researchers when conducting a smoke cost benefit transfer. On average, wildfire smoke in the Western US creates $165 million in annual morbidity and mortality health costs.


Assuntos
Poluentes Atmosféricos/efeitos adversos , Exposição Ambiental/economia , Custos de Cuidados de Saúde/tendências , Fumaça/efeitos adversos , Incêndios Florestais/economia , Análise Custo-Benefício , Humanos , Morbidade/tendências , Mortalidade/tendências , Noroeste dos Estados Unidos , Sudoeste dos Estados Unidos
17.
Environ Health ; 16(1): 55, 2017 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-28599657

RESUMO

BACKGROUND: Socioeconomic analysis is currently used in the Europe Union as part of the regulatory process in Regulation Registration, Evaluation and Authorisation of Chemicals (REACH), with the aim of assessing and managing risks from dangerous chemicals. The political impact of the socio-economic analysis is potentially high in the authorisation and restriction procedures, however, current socio-economic analysis dossiers submitted under REACH are very heterogeneous in terms of methodology used and quality. Furthermore, the economic literature is not very helpful for regulatory purposes, as most published calculations of health costs associated with chemical exposures use epidemiological studies as input data, but such studies are rarely available for most substances. The quasi-totality of the data used in the REACH dossiers comes from toxicological studies. METHODS: This paper assesses the use of the integrated probabilistic risk assessment, based on toxicological data, for the calculation of health costs associated with endocrine disrupting effects of triclosan. The results are compared with those obtained using the population attributable fraction, based on epidemiological data. RESULTS: The results based on the integrated probabilistic risk assessment indicated that 4894 men could have reproductive deficits based on the decreased vas deferens weights observed in rats, 0 cases of changed T3 levels, and 0 cases of girls with early pubertal development. The results obtained with the Population Attributable Fraction method showed 7,199,228 cases of obesity per year, 281,923 girls per year with early pubertal development and 88,957 to 303,759 cases per year with increased total T3 hormone levels. The economic costs associated with increased BMI due to TCS exposure could be calculated. Direct health costs were estimated at €5.8 billion per year. CONCLUSIONS: The two methods give very different results for the same effects. The choice of a toxicological-based or an epidemiological-based method in the socio-economic analysis will therefore significantly impact the estimated health costs and consequently the political risk management decision. Additional work should be done for understanding the reasons of these significant differences.


Assuntos
Disruptores Endócrinos/toxicidade , Exposição Ambiental , Saúde Ambiental/métodos , Poluentes Ambientais/toxicidade , Custos de Cuidados de Saúde , Triclosan/toxicidade , Disruptores Endócrinos/economia , Exposição Ambiental/economia , Saúde Ambiental/economia , Poluentes Ambientais/economia , União Europeia , Humanos , Medição de Risco , Triclosan/economia
19.
Arch Toxicol ; 91(8): 2745-2762, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28528477

RESUMO

Recently published papers have alleged that exposures to endocrine disrupting chemicals (EDCs) are causing substantial disease burdens in the EU and US and are consequently costing society hundreds of billions of dollars annually. To date, these cost estimates have not undergone adequate scientific scrutiny, but nevertheless are being used aggressively in advocacy campaigns in an attempt to fundamentally change how chemicals are tested, evaluated and regulated. Consequently, we critically evaluated the underlying methodology and assumptions employed by the chief architects of the disease burden cost estimates. Since the vast majority of their assigned disease burden costs are driven by the assumption that "loss of IQ" and "increased prevalence of intellectual disability" are caused by exposures to organophosphate pesticides (OPPs) and brominated flame retardants (PBDEs), we have taken special care in describing and evaluating the underlying toxicology and epidemiology evidence that was relied upon. Unfortunately, our review uncovered substantial flaws in the approach taken and the conclusions that were drawn. Indeed, the authors of these papers assumed causal relationships between putative exposures to EDCs and selected diseases, i.e., "loss of IQ" and "increased prevalence of intellectual disability", despite not having established them via a thorough evaluation of the strengths and weaknesses of the underlying animal toxicology and human epidemiology evidence. Consequently, the assigned disease burden costs are highly speculative and should not be considered in the weight of evidence approach underlying any serious policy discussions serving to protect the public and regulate chemicals considered as EDCs.


Assuntos
Efeitos Psicossociais da Doença , Disruptores Endócrinos/toxicidade , Exposição Ambiental/efeitos adversos , Animais , Exposição Ambiental/economia , Poluentes Ambientais/toxicidade , União Europeia , Retardadores de Chama/toxicidade , Éteres Difenil Halogenados/toxicidade , Humanos , Deficiência Intelectual/induzido quimicamente , Deficiência Intelectual/epidemiologia , Organofosfatos/toxicidade , Praguicidas/toxicidade , Estados Unidos
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