dioxin - a challenge for burden of disease estimation: results of the ebode project
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Dioxin - a Challenge for Burden of Disease Estimation:
Results of the EBoDE Project
International HIA 2011 Conference: In crisis times, healthier ways
Marianne Rappolder, André Conrad, Otto Hänninen, Annette Prüss-Üstün, Anne Knol, Matti Jantunen, Olli Leino Odile Mekel, Jurgen Buekers, Paolo Carrer, Thomas Classen, Ivano Iavarone, Rokho Kim Virpi Kollanus, Tek-Ang Lim, Rudi Torfs
Environmental Burden of Disease in Europe
Participating countries:Belgium
Finland
The Netherlands
France
Germany
Italy
15 April 2011 2International HIA 2011 Conference: In crisis times, healthier ways
http://en.opasnet.org/w/Ebode
Environmental Stressors
15 April 2011 3International HIA 2011 Conference: In crisis times, healthier ways
Outdoor Benzene OzoneParticulate Matter (PM10 und PM2,5)
Indoor: Radon in buildings Formaldehyde Second hand smoke
Noise: Traffic noise
Biomonitoring: Lead
Food: Dioxins + dioxin like PCB
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Overall results
Publ
iche
alth
impa
ct
Particulateair pollution
(6000- 10 000)
Passivesmoking
(300- 700)
Noise(1000- 1500)
Lead(200- 400)*
Ozone(40- 200)
Radon(600- 800)
Dioxins(0- 400)
Formaldehyde(0- 2)*
Benzene(2- 4)
.
High
Medium
Low
Certainty of the assessment
High Medium Low
Publ
iche
alth
impa
ct
Particulateair pollution
(6 000-10 000)
Second handsmoking
(600-900)
Traffic noise(500-1100)Lead
(100-500)
Ozone(40-200)
Radon
(600-1200) Dioxins(<500)
Formaldehyde(0-2)
Benzene(2-4)
DALYs per 1 million people, range of the 6 participating countries
15 April 2011 International HIA 2011 Conference: In crisis times, healthier ways
Non-discounted values
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Data and information needed
15 April 2011 International HIA 2011 Conference: In crisis times, healthier ways
Fraction of the population, affected by the environmental stressor
TotalBurden of Disease(specific endpoints)
Environmental Burden of Disease(specific endpoints)
Dose-response of specific environmental stressor
Exposure and population data
Epidemiology, Toxicology
Health data
Dioxins - Introduction
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Dioxin is not a single chemical• Dioxins are always found as a mixture of dioxins and
furans• Only the seventeen 2,3,7,8 congeners have dioxin-like
toxicity with different toxic power, concentration is expressed by Toxic EQuivalence (TEQ)
• Polychlorinated biphenyls (PCBs) with similar structure have dioxin-like toxicity (from 209 PCB congeners 12 PCBs) - are included in TEQ
• Daily intake estimation included these chemicals
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Dioxins – exposure
Main exposure root is via oral intake:
• About 90 % to 95 % of dioxin exposure in men is from food, mainly from animal fat
• Dioxins are bio accumulating - half life is 7 to 19 years, stored in fatty tissue (body burden)
• Dioxin and PCB contamination in most matrices have been decreased dramatically in the last decades
• The body burden increase with age, depends on dioxin contamination in food but also on eating habits and fat content of the body
15 April 2011 International HIA 2011 Conference: In crisis times, healthier ways
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Dioxins – daily intake estimationDioxin levels in food• National food monitoring programmes• Food baskets or duplication studiesFood Consumption• Food frequency questionnaire• Duplication studiesBody burden• Humanbiomonitoring and back-calculation
Problems• Dioxin and PCB contamination varies especially in fish
(e.g. Finland 0.2-14 pg/g TEQ), • Eating habits differ a lot
15 April 2011 International HIA 2011 Conference: In crisis times, healthier ways
Daily intake of Dioxins and dl PCBs
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Countries Population group Source Sampling
yearDioxin intake pg/kg bw/d
Belgium adults-fem.18-44 y
adults 50-65 yAdults - mean
Bilau 2008Bilau 2008Calculated
2002-062.091.74
1.9 (mean) Finland all Kiviranta et al
2005 2002 1.5
France 30-65 y Fréry et al. 2006 2004 2.3
Germany adults UBA 2005 2003 2.0
Italy 13 – 94 y Fattore et al 2006 1997-2003 2.3
Netherlands adults De Mul 2008 2004 1.0
International HIA 2011 Conference: In crisis times, healthier ways
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Comparison Human milk – daily intake
France was not includied in the WHO-Study
The daily intake from the Netherlands seemed to be underestimated
15 April 2011 International HIA 2011 Conference: In crisis times, healthier ways
Country Human milk
Daily intake
factor
ng TEQ/kg fat
ng TEQ/kg bw/d
Milk/intake
Belgium 29.5 1.9 16Finland 15.3 1.5 10Germany 26.2 2.0 13Italy 29.0 2.3 13Netherlands 29.8 1.0 30
0
5
10
15
20
25
30
35B
elgi
um
Finl
and
Ger
man
y
Italy
Net
herla
nds
Spa
in
ng W
HO-T
EQ/k
g fa
t (TE
F 19
98)
dl PCB
PCDD/F
Exposure - response
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Unit-risk (UR) approachCases = f(UR,Exposure)
• Dioxins (all cancer) UR = 1*10-3 pro pg/kg/d• All cancer cases are lethal
Advantage: absolute number, independent from background disease incidence
All other effects (immunotoxic, neurotoxic, toxic for reproduction and development, other endocrine disrupting effects were not considered due to lack of dose-response-function and countable endpoints
–
Health effects
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Prerequisites of quantifyable endpoints:• A validated dose-response function• Endpoint in humans measurable• Data of burden of disease in humans available
Problems:• Environmental stressors have effects in animal studies• Many different effects - difficult to measure and to
quantify in humans• Epidemiological data are usually from occupational health
from mixtures exposure, or by accident
Results of EBoDE
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Comparison of Countries
DALYs per milion people and country for dioxinsand dioxin-like PCBs (undiscounted, un-age-weighted)
Uncertainties and limitation
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• Exposure data (daily intake): very high variation
• Dose-response function: only for endpoint „all cancer“ - all other endpoints not included
• DALY-calculation includes only mortality (all cancer cases are considered to be lethal in the first year
• Health effect: non cancer effects not considered, e.g. endocrine disrupting effects difficult to have quantifyable endpoints
Conclusion and outlook
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• DALY for dioxins could be overestimated (all cancer lethal) or underestimated (no inclusion of non cancer effects)
• DALY-calculation is a suitable method for acute effects, specific endpoints, low variation in exposure
• DALY-method is useful for an initial estimation of the impact of a reduction measure for a chemical
• At this time: limited priorisation of environmental stressors based on DALY
• Further developing of EBD-Method is needed to take into account: effects of endocrine disruptors, low dose, mixture exposure
• Need for better dose responses functions from animal studies
Thank you for your attention!
Marianne [email protected]
Federal Environment Agency Germany, Berlin Corrensplatz
Measures for daily intake
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Type of measurement Type of use Specific limitations and uncertainties
A Survey (questionnaire) on food consumption
Information on food consumption and about the content of dioxins in representative food samples allow modelling of daily intake
Results are modelled for an average population - food contamination and eating habits can differ on a large scale
B Total diet studies The total diet in a population group over a certain time period and dioxin in this food or representative food samples are measured.
Results are only relevant for the investigated groups and not necessarily representative for the whole population, sampling period influence the results.
C Humanbiomonitoring Investigation of human milk or blood levels
Analyses of samples can show the body burden. Experimental scaling is used to convert observed biomonitoring results (blood) into daily intakes.
D-R function is based on daily intake. It had to calculate from body burden. Human milk or blood samples are not widely available. Different fat content of the bodies influences the results.
International HIA 2011 Conference: In crisis times, healthier ways