Reinhard Samson

The feasibility of estimating the total environmental burden of disease due to cadmium: experiences of the VegAS project

Abstract Background Cadmium is associated with several human health effects. Exposure via ambient background air is far less significant than through the food chain. The question is whether current concentrations of cadmium in the air still pose a health threat in terms of attributable cases of lung cancer in Germany. The German VegAS project (long title: Distribution-based analysis of the health effect of environmental stressors) quantified the environmental burden of disease (EBD) of cadmium in ambient air. Methods A comprehensive review of the literature until early 2012 was done to identify cadmium-induced health outcomes and exposure–response functions. Evidence was checked using predefined criteria. National data sources for health and exposure information were consulted to estimate disability-adjusted life-years (DALYs) lost due to cadmium. The range of uncertainty by variation of uncertain parameters was described in detail. Findings DALYs of lung cancer due to inhalation of cadmium in ambient background air in Germany (0·2131 ng/m 3 ) were quantifiable and estimated at 7 DALYs lost (0·0087 DALYs per 100 000 population). Uncertainty analysis using various unit risk estimates yielded a maximum of 348 DALYs. Interpretation By quantifying the EBD of airborne cadmium and lung cancer, only a very small part of the total EBD due to cadmium is quantified. Still, looking only at this small fraction of possible EBD due to cadmium, up to 348 DALYs (range maximum) could be prevented if this toxic substance was reduced to zero. Evidence supports an association between exposure to cadmium and kidney damage; bone disease; and lung, kidney, and prostate cancer. However, incompatibility of data affecting all dimensions of exposure and the EBD model undercut most quantification for supporting a scientifically validated environmental health policy. Funding The VegAS project was funded by the Federal Ministry of Environment, Nature Conservation, and Nuclear Safety in context of the Environment Research Plan 2009. The corresponding author had full access to all the data in the study and final responsibility for the decision to submit for publication.

Quantification of the health impact of environmental stressors in Germany for use in policy making: results of the VegAS project

Abstract Background The German VegAS project (long title: Distribution-based analysis of the health effect of environmental stressors) deals with the health impact of environmental stressors in Germany, aiming for a comparative risk assessment (CRA) using the environmental burden-of-disease (EBD) approach developed by WHO. Methods Extensive literature and data searches were conducted to determine the evidence-based environment–health relations of seven stressors (benzene, cadmium, noise [various types], ozone, particulate matter, perfluorinated compounds [PFC], and second-hand smoke) and their distribution of exposure in Germany. The EBD was expressed as lost disability-adjusted life-years (DALYs) attributable to these stressors. Uncertainties and limitations at different stages of the analysis were identified and discussed in detail. Moreover, an expert meeting was held to review the methods and data. The VegAS results were discussed regarding compatibility requirements of CRA. Findings DALYs attributable to the seven environmental stressors were determined for 11 health outcomes, some of them attributed to more than one stressor. Five stressors could be associated with years of life lost. The quality of EBD quantification was restricted by missing sources of exposure data, lack of exposure–response functions, or incomplete knowledge on the outcome weighting. DALY estimates were reported for all stressors except PFC. Interpretation A full DALY calculation failed for several outcomes because of insufficient or missing data. CRAs building on this approach should therefore be interpreted with caution. The VegAS results provide evidence-based, stressor-specific EBD estimates that can support informed decision making in environmental health. These estimates, however, should be used against the background of a detailed uncertainty analysis that should also help close data gaps, as applied in VegAS. Funding The VegAS project was funded by the Federal Ministry of Environment, Nature Conservation, and Nuclear Safety in context of the Environment Research Plan 2009. The corresponding author had full access to all the data in the study and final responsibility for the decision to submit for publication.