Leveraging Systematic Reviews to Explore Disease Burden and Costs of Per- and Polyfluoroalkyl Substance Exposures in the United States.

IF 4.5 3区 环境科学与生态学 Q1 WATER RESOURCES Exposure and Health Pub Date : 2023-01-01 Epub Date: 2022-07-26 DOI:10.1007/s12403-022-00496-y
Vladislav Obsekov, Linda G Kahn, Leonardo Trasande
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Abstract

Accelerating evidence confirms the contribution of per- and polyfluoroalkyl substances (PFAS) to disease burden and disability across the lifespan. Given that policy makers raise the high cost of remediation and of substituting PFAS with safer alternatives in consumer products as barriers to confronting adverse health outcomes associated with PFAS exposure, it is important to document the costs of inaction even in the presence of uncertainty. We therefore quantified disease burdens and related economic costs due to legacy PFAS exposures in the US in 2018. We leveraged systematic reviews and used meta-analytic inputs whenever possible, identified previously published exposure-response relationships, and calculated PFOA- and PFOS-attributable increases in 13 conditions. These increments were then applied to census data to determine total annual PFOA- and PFOS-attributable cases of disease, from which we calculated economic costs due to medical care and lost productivity using previously published cost-of-illness data. We identified PFAS-attributable disease costs in the US of $5.52 billion across five primary disease endpoints shown to be associated with PFAS exposure in meta-analyses. This estimate represented the lower bound, with sensitivity analyses revealing as much as $62.6 billion in overall costs. While further work is needed to assess probability of causation and establish with greater certainty effects of the broader category of PFAS, the results confirm further that public health and policy interventions are still necessary to reduce exposure to PFOA and PFOS and their endocrine-disrupting effects. This study demonstrates the large potential economic implications of regulatory inaction.

Supplementary information: The online version contains supplementary material available at 10.1007/s12403-022-00496-y.

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利用系统评价来探索美国全氟烷基和多氟烷基物质暴露的疾病负担和成本。
越来越多的证据证实,全氟烷基和多氟烷基物质(PFAS)在整个生命周期内对疾病负担和残疾的贡献。鉴于政策制定者提高了补救成本,并在消费品中用更安全的替代品取代全氟辛烷磺酸,这是应对与全氟辛烷酸暴露相关的不良健康后果的障碍,因此,即使在存在不确定性的情况下,也必须记录不作为的成本。因此,我们量化了2018年美国遗留PFAS暴露造成的疾病负担和相关经济成本。我们利用系统审查,尽可能使用荟萃分析输入,确定了先前公布的暴露-反应关系,并计算了13种情况下全氟辛烷磺酸和全氟辛烷值的增加。然后将这些增量应用于人口普查数据,以确定全氟辛烷磺酸和全氟辛烷酸可归因的年度疾病总病例,根据这些病例,我们使用先前公布的疾病成本数据计算了医疗保健和生产力损失造成的经济成本。我们在荟萃分析中发现,五个主要疾病终点的PFAS可归因疾病成本为55.2亿美元,与PFAS暴露有关。这一估计值代表了下限,敏感性分析显示总成本高达626亿美元。尽管还需要进一步的工作来评估因果关系的可能性,并更确定地确定更广泛类别的全氟辛烷磺酸的影响,但研究结果进一步证实,公共卫生和政策干预措施对于减少接触全氟辛烷酸和全氟辛烷氧及其内分泌干扰影响仍然是必要的。这项研究表明了监管不作为的巨大潜在经济影响。补充信息:在线版本包含补充材料,可访问10.1007/s12403-022-00496-y。
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来源期刊
Exposure and Health
Exposure and Health Environmental Science-Pollution
CiteScore
13.80
自引率
9.00%
发文量
71
期刊介绍: It is a multidisciplinary journal focused on global human health consequences of exposure to water pollution in natural and engineered environments. The journal provides a unique platform for scientists in this field to exchange ideas and share information on research for the solution of health effects of exposure to water pollution. Coverage encompasses Engineering sciences; Biogeochemical sciences; Health sciences; Exposure analysis and Epidemiology; Social sciences and public policy; Mathematical, numerical and statistical methods; Experimental, data collection and data analysis methods and more. Research topics include local, regional and global water pollution, exposure and health problems; health risk analysis of water pollution, methods of quantification and analysis of risk under uncertainty; aquatic biogeochemical processes in natural and engineered systems and health effects; analysis of pollution, exposure and health data; and more.
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