The Burden of Environmental Disease in the United States

By Pugh, Katherine H.; Zarus, Gregory M. | Journal of Environmental Health, May 2012 | Go to article overview

The Burden of Environmental Disease in the United States


Pugh, Katherine H., Zarus, Gregory M., Journal of Environmental Health


Introduction

The U.S. spends the most of any nation on health--over $2 trillion every year--yet ranks 37th in overall health among nations of the world (Healthiest Nation Alliance, 2011). Over 17% of the U.S. gross domestic product was spent on health expenditures in 2009 (Centers for Medicare and Medicaid Services, 2009). As our emphasis moves to health protection through health promotion, prevention, and preparedness, it is helpful to identify the economic burden of major disease groups in order to develop and support the best evidence-based health protection strategies. In an effort to establish environmental health prevention strategy targets, we have focused this report on defining the economic burden of environmental disease in the U.S.

The Top Environmental Disease Groups in the United States

In 2006, the World Health Organization (WHO) published a report entitled, "Preventing Disease Through Healthy Environments: Towards an Estimate of the Environmental Burden of Disease." WHO defined the environment as "all the physical, chemical, and biological factors external to the human host, and all related behaviors, but excluding those natural environments that cannot reasonably be modified (Pruss-Ustun & Corvalan, 2006)." WHO produced complimentary profiles for the countries examined in the report. These profiles detailed the major disease categories that made up each country's burden of environmental disease.

WHO used the disability-adjusted life year (DALY) to measure the burden of disease in the U.S. in 2004. A DALY is a weighted measure of death, illness, and disability. DALYs are calculated as the sum of the years of life lost due to premature mortality in the population and the years lost due to disability for cases of the disease. In the U.S., 13% of the total burden of disease is attributable to the environment. This amounts to 5,662,000 DALYs and 398,000 deaths annually (World Health Organization [WHO], 2007). The attributable fraction is the decline in disease or injury that could be achieved in a given population by reducing the risk (Pruss-Ustun & Corvalan, 2006).

Many environmental exposures are preventable; therefore, ranking disease groups by DALY and focusing prevention efforts on those groups that present the largest opportunity for impact is useful. Table 1 shows the 12 diseases with the greatest burden attributable to the environment in the U.S. and their associated DALYs. Our report focuses on those disease groups most applicable to the mission of the National Center for Environmental Health (NCEH)/Agency for Toxic Substances and Disease Registry (ATSDR). The mission of NCEH/ATSDR is to serve the public through responsive public health actions to promote healthy and safe environments and prevent harmful exposures. The following disease groups that are discussed in detail in this report are shown in bold type in Table 1.

Cardiovascular Disease

Cardiovascular disease accounts for the greatest burden of disease that is caused by the environment: 1,072,800 DALYs annually in the U.S. (WHO, 2007). Cardiovascular disease includes high blood pressure, coronary heart disease, congestive heart failure, and stroke. The estimated direct and indirect cost of all cardiovascular disease, attributable to the environment and otherwise, was $393.5 billion in 2005 (American Heart Association, 2005).

Cardiovascular disease is associated with environmental risks such as air pollution (Pope et al., 2002), occupational hazards (Steenland, Burnett, Lalich, Ward, & Hurrell, 2003), and lead exposure (Schwartz, 1995). Fine particulate-matter pollutants are strongly associated with cardiovascular mortality (Evans & Smith, 2002; Samet, Dominici, Curriero, Coursac, & Zeger, 2000).

Neuropsychiatric Disorders

Neuropsychiatric disorders account for the second-greatest burden of disease caused by the environment and are responsible for an estimated 894,000 DALYs annually in the U. …

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