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      Improving and Expanding Estimates of the Global Burden of Disease Due to Environmental Health Risk Factors

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          Abstract

          Background:

          The Global Burden of Disease (GBD) study, coordinated by the Institute for Health Metrics and Evaluation (IHME), produces influential, data-driven estimates of the burden of disease and premature death due to major risk factors. Expanded quantification of disease due to environmental health (EH) risk factors, including climate change, will enhance accuracy of GBD estimates, which will contribute to developing cost-effective policies that promote prevention and achieving Sustainable Development Goals.

          Objectives:

          We review key aspects of the GBD for the EH community and introduce the Global Burden of Disease–Pollution and Health Initiative (GBD-PHI), which aims to work with IHME and the GBD study to improve estimates of disease burden attributable to EH risk factors and to develop an innovative approach to estimating climate-related disease burden—both current and projected.

          Methods:

          We discuss strategies for improving GBD quantification of specific EH risk factors, including air pollution, lead, and climate change. We highlight key methodological challenges, including new EH risk factors, notably evidence rating and global exposure assessment.

          Discussion:

          A number of issues present challenges to the scope and accuracy of current GBD estimates for EH risk factors. For air pollution, minimal data exist on the exposure–risk relationships associated with high levels of pollution; epidemiological studies in high pollution regions should be a research priority. For lead, the GBD’s current methods do not fully account for lead’s impact on neurodevelopment; innovative methods to account for subclinical effects are needed. Decisions on inclusion of additional EH risk–outcome pairs need to be guided by findings of systematic reviews, the size of exposed populations, feasibility of global exposure estimates, and predicted trends in exposures and diseases. Neurotoxicants, endocrine-disrupting chemicals, and climate-related factors should be high priorities for incorporation into upcoming iterations of the GBD study. Enhancing the scope and methods will improve the GBD’s estimates and better guide prevention policy. https://doi.org/10.1289/EHP5496

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          Stephen S Lim, Theo Vos, Abraham D. Flaxman … (2012)
          The Lancet, 380(9859), 2224-2260
          Article 0 comments Cited 3869 times – based on 0 reviews     Review now
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            Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter

            Richard Burnett, Hong Chen, Mieczysław Szyszkowicz … (2018)
            Significance Exposure to outdoor concentrations of fine particulate matter is considered a leading global health concern, largely based on estimates of excess deaths using information integrating exposure and risk from several particle sources (outdoor and indoor air pollution and passive/active smoking). Such integration requires strong assumptions about equal toxicity per total inhaled dose. We relax these assumptions to build risk models examining exposure and risk information restricted to cohort studies of outdoor air pollution, now covering much of the global concentration range. Our estimates are severalfold larger than previous calculations, suggesting that outdoor particulate air pollution is an even more important population health risk factor than previously thought.
            Article 0 comments Cited 679 times – based on 0 reviews     Review now
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              Low-Level Environmental Lead Exposure and Children’s Intellectual Function: An International Pooled Analysis

              Bruce Lanphear, Richard Hornung, Jane Khoury … (2005)
              Lead is a confirmed neurotoxin, but questions remain about lead-associated intellectual deficits at blood lead levels < 10 μg/dL and whether lower exposures are, for a given change in exposure, associated with greater deficits. The objective of this study was to examine the association of intelligence test scores and blood lead concentration, especially for children who had maximal measured blood lead levels < 10 μg/dL. We examined data collected from 1,333 children who participated in seven international population-based longitudinal cohort studies, followed from birth or infancy until 5–10 years of age. The full-scale IQ score was the primary outcome measure. The geometric mean blood lead concentration of the children peaked at 17.8 μg/dL and declined to 9.4 μg/dL by 5–7 years of age; 244 (18%) children had a maximal blood lead concentration < 10 μg/dL, and 103 (8%) had a maximal blood lead concentration < 7.5 μg/dL. After adjustment for covariates, we found an inverse relationship between blood lead concentration and IQ score. Using a log-linear model, we found a 6.9 IQ point decrement [95% confidence interval (CI), 4.2–9.4] associated with an increase in concurrent blood lead levels from 2.4 to 30 μg/dL. The estimated IQ point decrements associated with an increase in blood lead from 2.4 to 10 μg/dL, 10 to 20 μg/dL, and 20 to 30 μg/dL were 3.9 (95% CI, 2.4–5.3), 1.9 (95% CI, 1.2–2.6), and 1.1 (95% CI, 0.7–1.5), respectively. For a given increase in blood lead, the lead-associated intellectual decrement for children with a maximal blood lead level < 7.5 μg/dL was significantly greater than that observed for those with a maximal blood lead level ≥7.5 μg/dL (p = 0.015). We conclude that environmental lead exposure in children who have maximal blood lead levels < 7.5 μg/dL is associated with intellectual deficits.
              Article 0 comments Cited 481 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Environ Health Perspect
                Journal ID (iso-abbrev): Environ. Health Perspect
                Journal ID (publisher-id): EHP
                Title: Environmental Health Perspectives
                Publisher: Environmental Health Perspectives
                ISSN (Print): 0091-6765
                ISSN (Electronic): 1552-9924
                Publication date (Electronic): 18 October 2019
                Publication date Collection: October 2019
                Volume: 127
                Issue: 10
                Electronic Location Identifier: 105001
                Affiliations
                [1 ]Department of Environmental and Occupational Health Sciences, University of Washington , Seattle, Washington, USA
                [2 ]Center for Health and the Global Environment, University of Washington , Seattle, Washington, USA
                [3 ]Evans School of Public Policy and Governance, University of Washington , Seattle, Washington, USA
                [4 ]Institute for Health Metrics and Evaluation, University of Washington , Seattle, Washington, USA
                [5 ]Department of Health Metrics Sciences, University of Washington , Seattle, Washington, USA
                [6 ]Department of Epidemiology, University of Washington , Seattle, Washington, USA
                [7 ]Milken Institute School of Public Health, George Washington University , Washington, DC, USA
                [8 ]Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services , Bethesda, Maryland, USA
                [9 ]Faculty of Agricultural and Environmental Sciences, McGill University , Montreal, Quebec, Canada
                [10 ]Department of Neurology, Harvard Medical School, Boston Children’s Hospital , Boston, Massachusetts, USA
                [11 ]Office of the Director, National Institute of Environmental Health Sciences, National Institutes of Health, Department of Health and Human Services , Research Triangle Park, North Carolina, USA
                [12 ]School of Population and Public Health, The University of British Columbia , Vancouver, British Columbia, Canada
                [13 ]Health Effects Institute , Boston, Massachusetts, USA
                [14 ]Pure Earth , New York, New York, USA
                [15 ]Department of Public Health, University of Southern Denmark , Odense, Denmark
                [16 ]Department of Environmental Health, Harvard T.H. Chan School of Public Health , Boston, Massachusetts, USA
                [17 ]Barcelona Institute for Global Health , Barcelona, Spain
                [18 ]United Nations Programme on the Environment, Nairobi, Kenya
                [19 ]Program in Global Public Health and the Common Good, Boston College , Chestnut Hill, Massachusetts, USA
                [20 ]Global Observatory on Pollution and Health, Boston College , Chestnut Hill, Massachusetts, USA
                [21 ]Simon Fraser University , Vancouver, British Columbia, Canada
                [22 ]Epidemiology Branch, National Institutes of Health, Department of Health and Human Services , Research Triangle Park, North Carolina, USA
                [23 ]Division of the National Toxicology Program, National Institutes of Health, Department of Health and Human Services , Research Triangle Park, North Carolina, USA
                [24 ]Department of Pediatrics, New York University School of Medicine , New York, New York, USA
                [25 ]NYU Global Institute of Public Health, New York University , New York, New York, USA
                [26 ]Department of Environmental Health Sciences, University of Michigan School of Public Health , Ann Arbor, Michigan, USA
                Author notes
                Address correspondence to Howard Hu, F-226B, University of Washington SPH, 1959 NE Pacific St., Seattle, WA 98195, USA. Telephone: (206) 685-7243. EMAIL: hhu5@ 123456uw.edu
                Article
                Publisher ID: EHP5496
                DOI: 10.1289/EHP5496
                PMC ID: 6867191
                PubMed ID: 31626566
                SO-VID: 1fd77890-7395-450c-b5b4-36d9f32df2fe
                License:

                EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted.

                History
                Date received : 22 April 2019
                Date revision received : 20 August 2019
                Date accepted : 25 September 2019
                Categories
                Subject: Commentary

                ScienceOpen disciplines: Public health
                Data availability:
                ScienceOpen disciplines: Public health

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