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Ulziikhuu B, Gombojav E, Banzrai C, Batsukh S, Enkhtuya E, Boldbaatar B, Bellinger DC, Lanphear BP, McCandless LC, Tamana SK, Allen RW. Portable HEPA Filter Air Cleaner Use during Pregnancy and Children's Cognitive Performance at Four Years of Age: The UGAAR Randomized Controlled Trial. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:67006. [PMID: 35730943 PMCID: PMC9221428 DOI: 10.1289/ehp10302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
BACKGROUND Developmental exposure to air pollution is associated with diminished cognitive abilities in observational studies, but no randomized controlled trial has examined the effect of reducing air pollution on cognition in children. OBJECTIVES We sought to quantify the impact of reducing exposure to particulate matter (PM) during pregnancy on children's cognitive performance at 4 y of age. METHODS In this single-blind, parallel-group, randomized controlled trial in Ulaanbaatar, Mongolia, we randomly assigned 540 nonsmoking pregnant women (268 intervention and 272 control) to receive 1-2 portable high-efficiency particulate air (HEPA) filter air cleaners or no air cleaners. The air cleaners were used from a median of 11 wk gestation until the end of pregnancy. The primary outcome was full-scale intelligence quotient (FSIQ) assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) when children were a median of 48 months old. We imputed missing outcome data using multiple imputation with chained equations, and our primary analysis was by intention to treat. RESULTS After excluding known miscarriages, stillbirths, neonatal deaths, and medical conditions that impeded cognitive testing and imputation, 475 (233 control and 242 intervention) children were included in our analyses. In an unadjusted analysis, the mean FSIQ of children who were randomly assigned to the intervention group was 2.5 points [95% confidence interval (CI): -0.4, 5.4 points] higher than that of children in the control group. After adjustment to account for an imbalance in preterm birth between groups, the effect estimate increased to 2.8 points (95% CI: -0.1, 5.7). CONCLUSIONS Reducing PM air pollution during pregnancy may improve cognitive performance in childhood. https://doi.org/10.1289/EHP10302.
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Affiliation(s)
| | | | | | - Sarangerel Batsukh
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Enkhtuul Enkhtuya
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | | | | | | | | | - Ryan W. Allen
- Simon Fraser University, Burnaby, British Columbia, Canada
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2
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Kassotis CD, Trasande L. Endocrine disruptor global policy. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2021; 92:1-34. [PMID: 34452684 DOI: 10.1016/bs.apha.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the past several decades, scientific consensus has grown around the concept and evidence for human health impacts from exposure to endocrine disrupting chemicals (EDCs). A series of publications have now demonstrated considerable economic costs of EDC exposure-induced adverse health outcomes. This research has suggested economic burdens in the hundreds of billions, even considering only a small subset of EDCs and health. As of yet, regulatory efforts and policies to protect and decrease human exposure to most EDCs have been insufficient and have not kept pace with the science. Given the overwhelming scientific evidence, referenced throughout this collection, as well as the economic costs of inaction, described here, regulations are clearly needed. The EU and some other countries have taken promising steps towards protective regulation of EDCs, though the response of the US and many other countries has been limited or altogether lacking. Regulatory bodies that have and continue to apply risk-based approaches to regulating EDCs have also failed to consider the complete economic impacts of EDC-related health impacts. In this chapter, we will discuss broad strategies taken to regulate EDCs, examine the approaches currently taken to regulate EDCs in a global context (discussing the strengths and weaknesses of these regulations), discuss the economic costs of EDC exposures (detailing where consideration of health and economic costs could improve regulations), and discuss next steps and novel approaches to adapting existing regulatory frameworks to this class of chemicals.
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Affiliation(s)
- Christopher D Kassotis
- Institute of Environmental Health Sciences and Department of Pharmacology, School of Medicine, Wayne State University, Detroit, MI, United States.
| | - Leonardo Trasande
- Departments of Pediatrics, New York University School of Medicine, New York, NY, United States; Department of Environmental Medicine, New York University School of Medicine, New York, NY, United States; Department of Population Health, New York University School of Medicine, New York, NY, United States; NYU College of Global Public Health, New York, NY, United States
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Monetary Valuation of Children's Cognitive Outcomes in Economic Evaluations from a Societal Perspective: A Review. CHILDREN-BASEL 2021; 8:children8050352. [PMID: 33946651 PMCID: PMC8146900 DOI: 10.3390/children8050352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 04/25/2021] [Indexed: 01/12/2023]
Abstract
Cognitive ability in childhood is positively associated with economic productivity in adulthood. Expected gains in economic output from interventions that protect cognitive function can be incorporated in benefit-cost and cost-effectiveness analyses conducted from a societal perspective. This review summarizes estimates from high-income countries of the association of general cognitive ability, standardized as intelligence quotient (IQ), with annual and lifetime earnings among adults. Estimates of the association of adult earnings with cognitive ability assessed in childhood or adolescence vary from 0.5% to 2.5% per IQ point. That range reflects differences in data sources and analytic methods. We take a conservative published estimate of a 1.4% difference in market productivity per IQ point in the United States from a recent study that controlled for confounding by family background and behavioral attributes. Using that estimate and the present value of lifetime earnings calculated using a 3% discount rate, the implied lifetime monetary valuation of an IQ point in the United States is USD 10,600-13,100. Despite uncertainty and the exclusion of non-market productivity, incorporation of such estimates could lead to a fuller assessment of the benefits of public health and clinical interventions that protect the developing brains of fetuses, infants, and young children.
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Kassotis CD, Vandenberg LN, Demeneix BA, Porta M, Slama R, Trasande L. Endocrine-disrupting chemicals: economic, regulatory, and policy implications. Lancet Diabetes Endocrinol 2020; 8:719-730. [PMID: 32707119 PMCID: PMC7437819 DOI: 10.1016/s2213-8587(20)30128-5] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 12/12/2022]
Abstract
Endocrine-disrupting chemicals (EDCs) substantially cost society as a result of increases in disease and disability but-unlike other toxicant classes such as carcinogens-have yet to be codified into regulations as a hazard category. This Series paper examines economic, regulatory, and policy approaches to limit human EDC exposures and describes potential improvements. In the EU, general principles for EDCs call for minimisation of human exposure, identification as substances of very high concern, and ban on use in pesticides. In the USA, screening and testing programmes are focused on oestrogenic EDCs exclusively, and regulation is strictly risk-based. Minimisation of human exposure is unlikely without a clear overarching definition for EDCs and relevant pre-marketing test requirements. We call for a multifaceted international programme (eg, modelled on the International Agency for Research in Cancer) to address the effects of EDCs on human health-an approach that would proactively identify hazards for subsequent regulation.
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Affiliation(s)
| | - Laura N Vandenberg
- School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Barbara A Demeneix
- Centre National de la Recherche Scientifique, UMR 7221, Muséum National d'Histoire Naturelle, Paris, France; Université Paris-Sorbonne, Paris, France
| | - Miquel Porta
- Hospital del Mar Medical Research Institute, PSMAR, Barcelona, Spain; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Barcelona, Spain; School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Remy Slama
- Team of Environmental Epidemiology applied to Reproduction and Respiratory Health, Institute for Advanced Biosciences, INSERM, U1209, CNRS, UMR 5309, Université Grenoble Alpes, Grenoble, France
| | - Leonardo Trasande
- Department of Pediatrics, Environmental Medicine, and Population Health, New York University Grossman School of Medicine, New York, NY, USA; NYU College of Global Public Health, New York, NY, USA.
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Kim JJ, Axelrad DA, Dockins C. Preterm birth and economic benefits of reduced maternal exposure to fine particulate matter. ENVIRONMENTAL RESEARCH 2019; 170:178-186. [PMID: 30583127 PMCID: PMC6423977 DOI: 10.1016/j.envres.2018.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/27/2018] [Accepted: 12/06/2018] [Indexed: 05/13/2023]
Abstract
Preterm birth (PTB) is a predictor of infant mortality and later-life morbidity. Despite recent declines, PTB rates remain high in the United States. Growing research suggests a possible relationship between a mother's exposure to common air pollutants, including fine particulate matter (PM2.5), and PTB of her baby. Many policy actions to reduce exposure to common air pollutants require benefit-cost analysis (BCA), and it's possible that PTB will need to be included in BCA in the future. However, an estimate of the willingness to pay (WTP) to avoid PTB risk is not available, and a comprehensive alternative valuation of the health benefits of reducing pollutant-related PTB currently does not exist. This paper demonstrates an approach to assess potential economic benefits of reducing PTB resulting from environmental exposures when an estimate of WTP to avoid PTB risk is unavailable. We utilized a recent meta-analysis, county-level air quality data and county-level PTB prevalence data to estimate the potential health and economic benefits of a reduction in air pollution-related PTB, with PM2.5 as our case study pollutant. Using this method, a simulated nationwide 10% decrease from 2008 PM2.5 levels resulted in an estimated reduction of 5016 PTBs and benefits of at least $339 million, potentially reaching over one billion dollars when considering later-life effects of PTB.
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Affiliation(s)
- Jina J Kim
- ASPPH/EPA Environmental Health Fellowship Program, Hosted by US Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, D.C. 20460, USA.
| | - Daniel A Axelrad
- National Center for Environmental Economics, Office of Policy, US Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, D.C. 20460, USA
| | - Chris Dockins
- National Center for Environmental Economics, Office of Policy, US Environmental Protection Agency, 1200 Pennsylvania Ave. NW, Washington, D.C. 20460, USA
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Bellinger DC, Devleesschauwer B, O'Leary K, Gibb HJ. Global burden of intellectual disability resulting from prenatal exposure to methylmercury, 2015. ENVIRONMENTAL RESEARCH 2019; 170:416-421. [PMID: 30623889 DOI: 10.1016/j.envres.2018.12.042] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/25/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
We describe analyses to estimate the global burden of disease associated with methylmercury (MeHg). An intelligence quotient < 70, indicating intellectual disability (ID), was selected as the critical disease, maternal hair Hg concentration during pregnancy selected as the critical exposure biomarker, and a dose-effect relationship of an 0.18 point IQ reduction per µg/g increase in maternal hair Hg was assumed, based on a meta-analysis. A systematic review was conducted to obtain country-specific data on the distribution of maternal hair Hg concentrations. The country-specific incidence of MeHg-associated ID was calculated, and a random effects model was used to impute the incidence for countries for which no exposure data could be found. The global burden of MeHg-associated ID was quantified in terms of Disability-Adjusted Life Years (DALYs) using the World Health Organization (WHO) Global Health Estimates methodology, and presented by 14 subregions. In 2015, the global total for MeHg-associated cases of ID was 226,655; 210,074 of these cases (93%) were mild cases of ID. The highest rate of ID (6 cases per 100,000 population) was found in the Americas D subregion. The global DALY estimate was 1,963,869. The Western Pacific B subregion contributed the most to this total (696,417), although the Americas D subregion had the greatest rate (54 DALYs per 100,000 population). The burden of disease associated with MeHg is therefore highly subregion-dependent even in areas that are geographically related. The priority given to reducing this burden can therefore be expected to vary considerably by subregion depending on other health needs.
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Affiliation(s)
- David C Bellinger
- Departments of Neurology and Psychiatry, Harvard Medical School; Department of Environmental Health, Harvard T.H. Chan School of Public Health; Boston Children's Hospital, Boston, MA, USA
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium; Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
| | - Keri O'Leary
- Gibb Epidemiology Consulting LLC, Arlington, VA, USA; George Washington University Milken Institute School of Public Health, Washington, D.C., USA
| | - Herman J Gibb
- Gibb Epidemiology Consulting LLC, Arlington, VA, USA; George Washington University Milken Institute School of Public Health, Washington, D.C., USA
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Abstract
Strong evidence now supports the notion that organophosphate pesticides damage the fetal brain and produce cognitive and behavioral dysfunction through multiple mechanisms, including thyroid disruption. A regulatory ban was proposed, but actions to end the use of one such pesticide, chlorpyrifos, in agriculture were recently stopped by the Environmental Protection Agency under false scientific pretenses. This manuscript describes the costs and consequences of this policy failure and notes how this case study is emblematic of a broader dismissal of scientific evidence and attacks on scientific norms. Scientists have a responsibility to rebut and decry these serious challenges to human health and scientific integrity.
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Affiliation(s)
- Leonardo Trasande
- Department of Pediatrics, New York University School of Medicine, New York, New York, United States of America
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, United States of America
- Department of Population Health, New York University School of Medicine, New York, New York, United States of America
- NYU Wagner School of Public Service, New York University, New York, New York, United States of America
- NYU College of Global Public Health, New York University, New York, New York, United States of America
- * E-mail:
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Environmental Health: Lessons from the Past and Looking to the Future. Ann Am Thorac Soc 2017; 14:1378-1382. [PMID: 28820615 DOI: 10.1513/annalsats.201706-455ps] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lam J, Lanphear BP, Bellinger D, Axelrad DA, McPartland J, Sutton P, Davidson L, Daniels N, Sen S, Woodruff TJ. Developmental PBDE Exposure and IQ/ADHD in Childhood: A Systematic Review and Meta-analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2017; 125:086001. [PMID: 28799918 PMCID: PMC5783655 DOI: 10.1289/ehp1632] [Citation(s) in RCA: 154] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/28/2017] [Accepted: 04/28/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND In the United States, one in six children are affected by neurodevelopmental disorders, and polybrominated diphenyl ethers (PBDEs) in flame-retardant chemicals are measured ubiquitously in children. OBJECTIVE We conducted a systematic a systematic review regarding developmental exposure to PBDEs and intelligence or Attention Deficit/Hyperactivity Disorder (ADHD) and attention-related behavioral conditions in humans. METHODS We searched articles published up to 26 September 2016, and included original studies that quantified exposures to PBDEs incurred any time in proximity to conception or during in utero, perinatal, or childhood time periods. We evaluated the risk of bias of individual studies and the overall quality and strength of the evidence according to the Navigation Guide systematic review methodology. We established criteria in advance to identify studies that could be combined using random effects meta-analyses (DerSimonian-Laird method). RESULTS Fifteen studies met the inclusion criteria; 10 studies met the criteria for intelligence and nine for attention-related problems. We rated studies generally with "low" to "probably low" risk of bias and rated the overall body of evidence as "moderate" quality with "sufficient" evidence for an association between Intelligence Quotient (IQ) and PBDEs. Our meta-analysis of four studies estimated a 10-fold increase (in other words, times 10) in PBDE exposure associated with a decrement of 3.70 IQ points (95% confidence interval: 0.83, 6.56). We concluded the body of evidence was of "moderate" quality for ADHD with "limited" evidence for an association with PBDEs, based on the heterogeneity of association estimates reported by a small number of studies and the fact that chance, bias, and confounding could not be ruled out with reasonable confidence. CONCLUSION We concluded there was sufficient evidence supporting an association between developmental PBDE exposure and reduced IQ. Preventing developmental exposure to PBDEs could help prevent loss of human intelligence. https://doi.org/10.1289/EHP1632.
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Affiliation(s)
- Juleen Lam
- Program on Reproductive Health and the Environment, University of California , San Francisco, San Francisco, California, USA
| | | | - David Bellinger
- Harvard School of Public Health, Harvard University , Boston, Massachusetts, USA
| | - Daniel A Axelrad
- Office of Policy, U.S. Environmental Protection Agency , Washington, District of Columbia, USA
| | | | - Patrice Sutton
- Program on Reproductive Health and the Environment, University of California , San Francisco, San Francisco, California, USA
| | - Lisette Davidson
- Department of Obstetrics and Gynecology, Kaiser Permanente , Oakland, California, USA
| | - Natalyn Daniels
- Program on Reproductive Health and the Environment, University of California , San Francisco, San Francisco, California, USA
| | - Saunak Sen
- University of Tennessee Health Science Center , Memphis, Tennessee, USA
| | - Tracey J Woodruff
- Program on Reproductive Health and the Environment, University of California , San Francisco, San Francisco, California, USA
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Susceptibility Based Upon Chemical Interaction with Disease Processes: Potential Implications for Risk Assessment. Curr Environ Health Rep 2014. [DOI: 10.1007/s40572-014-0030-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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