Academic journal article Environmental Health Perspectives

Environmental Pollutants and Disease in American Children: Estimates of Morbidity, Mortality, and Costs for Lead Poisoning, Asthma, Cancer, and Developmental Disabilities. (Children's Health Articles)

Academic journal article Environmental Health Perspectives

Environmental Pollutants and Disease in American Children: Estimates of Morbidity, Mortality, and Costs for Lead Poisoning, Asthma, Cancer, and Developmental Disabilities. (Children's Health Articles)

Article excerpt

In this study, we aimed to estimate the contribution of environmental pollutants to the incidence, prevalence, mortality, and costs of pediatric disease in American children, We examined four categories of illness: lead poisoning, asthma, cancer, and neurobehavioral disorders. To estimate the proportion of each attributable to toxins in the environment, we used an environmentally attributable fraction (EAF) model. EAFs for lead poisoning, asthma, and cancer were developed by panels of experts through a Delphi process, whereas that for neurobehavioral disorders was based on data from the National Academy of Sciences. We define environmental pollutants as toxic chemicals of human origin in air, food, water, and communities. To develop estimates of costs, we relied on data from the U.S. Environmental Protection Agency, Centers for Disease Control and Prevention, National Center for Health Statistics, the Bureau of Labor Statistics, the Health Care Financing Agency, and the Practice Management Information Corporation. EAFs were judged to be 100% for lead poisoning, 30% for asthma (range, 10-35%), 5% for cancer (range, 2-10%), and 10% for neurobehavioral disorders (range, 5-20%). Total annual costs are estimated to be $54.9 billion (range $48.8-64.8 billion): $43.4 billion for lead poisoning, $2.0 billion for asthma, $0.3 billion for childhood cancer, and $9.2 billion for neurobehavioral disorders. This sum amounts to 2.8 percent of total U.S. health care costs. This estimate is likely low because it considers only four categories of illness, incorporates conservative assumptions, ignores costs of pain suffering, and does not include late complications for which etiologic associations are poorly quantified. The costs of pediatric environmental disease are high, in contrast with the limited resources directed to research, tracking, and prevention. Key words: asthma, cancer, developmental disabilities, environmental pediatrics, health economics, lead poisoning.

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Patterns of illness among children in the United States have changed substantially in the past century (1). The classic infectious diseases are much reduced in incidence and are no longer the leading causes of illness and death (2). Infant mortality has been lowered, although not equally across American society, and life expectancy increased. Today the most serious diseases confronting children in the United States and in other industrially developed nations are a group of chronic conditions of multifactorial origin that have been termed the "new pediatric morbidity" (1). Examples include asthma, for which incidence has more than doubled (3,4); childhood cancer, for which reported incidence of certain types has increased significantly (5,6); neurodevelopmental and behavioral disorders (7,8); and certain congenital defects (9,10).

An important unresolved question is the extent to which chemical pollutants in the environment may be contributing to these changing patterns of pediatric disease (11). More than 80,000 new synthetic chemical compounds have been developed over the past 50 years, and each year 2,000 to 3,000 new chemicals are brought to the U.S. Environmental Protection Agency (EPA) for review before manufacture. Children are especially at risk of exposure to the 15,000 chemicals produced in quantities greater than 10,000 pounds per year and to the 2,800 produced in quantities greater than 1 million pounds per year. These high-volume chemicals have the greatest potential to be dispersed in air, water, food crops, communities, and homes (11). Only 43% of high-volume chemicals have been tested for their potential human toxicity, and only 7% have been studied for their possible effects on development (12,13).

Children are more vulnerable than adults to many chemicals (14). This susceptibility results from children's disproportionately heavy exposures coupled with the biologic sensitivity that is an inherent characteristic of early growth and development. …

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