Estimating the environmental burden of disease resulting from exposure to chemicals in European countries - Potentials and challenges revealed in selected case studies.

Background: The increased use of chemicals leads to a continuous deposition of chemicals in the environment and to a continuous increase in exposure of the global and the European population. Comprehensive burden of disease analyses are however still missing for many countries.

Methods: Using the World Health Organization's Environmental Burden of Disease (EBD) approach and combining data from the European Human Biomonitoring (HBM) dashboard with disease and population data, we estimated the comprehensive attributable burden (AB) for the year 2021, in the best-case quantified by disability-adjusted life years (DALY). First analyses were performed for cadmium, per- and polyfluoroalkyl substances (PFAS) and phthalates.

Results: For cadmium, the highest AB for chronic kidney disease was calculated for Czechia with about 142 (95% confidence interval (CI): 3-409) years lived with disability (YLDs) per 1,000,000 persons. For osteoporosis related to cadmium, the highest AB was estimated for Poland with 2,024 (95% CI: 946-2,761) DALYs per 1,000,000 persons. For perfluorooctanoic acid (PFOA), the highest AB was associated with hypertension in Spain with about 2,591 (95% CI: 1,003-4,193) years of life lost (YLL) per 1,000,000 persons. For phthalates, the highest AB due to DiNP-exposure associated with obesity was 11,324 (95% CI: 1,929-22,391) cases per 1,000,000 persons. The highest AB for diabetes mellitus due to DEHP-exposure was estimated with 1,324 (95% CI: 49-2,476) YLDs per 1,000,000 women in Poland.

Discussion: Overall, we have identified many relevant challenges when estimating the burden attributable to the selected chemicals. Especially the missing data (e.g. HBM data for countries, age groups or sex) need to be tackled by more primary data or adequate gap filing techniques.