Environmental Burden of Childhood Disease in Europe

Background: Environmental factors determine children’s health. Quantifying the health impacts related to environmental hazards for children is essential to prioritize interventions to improve health in Europe. Objective: This study aimed to assess the burden of childhood disease due to environmental risks across the European Union. Methods: We conducted an environmental burden of childhood disease assessment in the 28 countries of the EU (EU28) for seven environmental risk factors (particulate matter less than 10 micrometer of diameter (PM10) and less than 2.5 micrometer of diameter (PM2.5), ozone, secondhand smoke, dampness, lead, and formaldehyde). The primary outcome was disability-adjusted life years (DALYs), assessed from exposure data provided by the World Health Organization, Global Burden of Disease project, scientific literature, and epidemiological risk estimates. Results: The seven studied environmental risk factors for children in the EU28 were responsible for around 211,000 DALYs annually. Particulate matter (PM10 and PM2.5) was the main environmental risk factor, producing 59% of total DALYs (125,000 DALYs), followed by secondhand smoke with 20% of all DALYs (42,500 DALYs), ozone 11% (24,000 DALYs), dampness 6% (13,000 DALYs), lead 3% (6200 DALYs), and formaldehyde 0.2% (423 DALYs). Conclusions: Environmental exposures included in this study were estimated to produce 211,000 DALYs each year in children in the EU28, representing 2.6% of all DALYs in children. Among the included environmental risk factors, air pollution (particulate matter and ozone) was estimated to produce the highest burden of disease in children in Europe, half of which was due to the effects of PM10 on infant mortality. Effective policies to reduce environmental pollutants across Europe are needed.

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Skills building seminar: Environmental Burden of Disease: methods and applications

European Journal of Public Health ◽

10.1093/eurpub/ckz185.654 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

Keyword(s):

Risk Factors ◽

Environmental Risk ◽

Burden Of Disease ◽

Premature Death ◽

Environmental Risk Factors ◽

World Health ◽

Mitigation Measures ◽

Environmental Burden ◽

State Of Research ◽

Health Organization

Abstract There is an increasing body of evidence showing that environmental risk factors can cause illness and death. For example, particulate matter triggers lung cancer and noise increases the risk of heart attack. Consequently, governments worldwide should aim to mitigate the negative health effects of environmental exposures. The concept of Environmental Burden of Disease (EBD) aims to quantify the number of illnesses and deaths associated with various environmental risk factors, as well as the health benefits of potential prevention and mitigation measures. Current EBD studies commonly use the Disability-Adjusted Life Year (DALY) metric as a common currency for integrating the effects of ill health and premature death, thereby facilitating the comparison of the burden of various environmental risk factors amongst each other and with other risk factors. The EBD approach has been used since the 1990s, spearheaded by the World Health Organization. However, even today, the approach is not yet commonly adopted across Europe, mainly because of a lack of capacity. At the same time, the EBD approach remains in full development, trying to adapt to the current state of research. The overall aim of this skills building seminar is therefore to a) create awareness of the EBD approach, and b) to present and discuss current methodologies and future developments. The skills building seminar consists of four presentations. In the first presentation, the history and general methodological framework of the EBD approach will be outlined. Next, three presentations will present EBD case studies. These presentations will explain in a didactic, step-by-step way how the estimates were produced, and how technical challenges were addressed. Finally, ample time will be foreseen to discuss methodologies, challenges, possible solutions, and future collaborations to increase EBD capacity within Europe. Key messages Participants will gain insights in the use, strengths and weaknesses of the Environmental Burden of Disease approach. Participants will develop an understanding of current Environmental Burden of Disease methodology.

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Introduction to the Environmental Burden of Disease concept – history, methods and selected results

European Journal of Public Health ◽

10.1093/eurpub/ckz185.655 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

D Plass ◽

M Tobollik ◽

D Wintermeyer

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Population Health ◽

Environmental Risk ◽

Burden Of Disease ◽

Disease Burden ◽

Environmental Risk Factors ◽

Attributable Fraction ◽

Environmental Risk Factor ◽

Environmental Burden

Abstract Background The Environmental Burden of Disease (EBD)-concept was introduced by the World Health Organization to quantify the impacts of environmental risk factors on population health in a comprehensive and comparable way. Since the first Global Burden of Disease (GBD)-study the EBD-methodology was used in numerous global, regional and national assessments. Methods In the EBD-concept data from different sources are joined using a standardized framework. To calculate the EBD several steps need to be taken into account. First, the exposure of the selected population towards an environmental risk factor is estimated. In a second step, exposure data and information from an exposure-response-function are combined by using the population attributable fraction formula. In a last step, the attributable fraction (percentage) is multiplied by the disease burden resulting from a selected health outcome to estimate the share of disease burden attributable to the environmental risk factor. Results Since the first GBD-study several stakeholders have used the EBD-concept to estimate the disease burden attributable to environmental risk factors. This lead to an increased number of available data sets, which - due to the varying assumptions used in the models - are not ad hoc comparable among each other. Generally, the results of EBD-assessments are presented using disability-adjusted life years (DALY) as the core measure of burden of disease assessments. However, e. g. due to lack of data, assessments also focus on the number of attributable deaths, illnesses or single components of the DALY such as the years of life lost due to premature mortality (YLL). Conclusions The EBD-concept allows to compare the impact of environmental risk factors on population health. Though the general concept is widely standardized, assumptions on model parameters can lead to varying results. Therefore, when communicating EBD-results it is necessary to be very transparent about data and model inputs.

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