SETURI: National estimates of DALY of environmental risks

<accesscontrol>seturi_group</accesscontrol>

The purpose of this page is to serve as a forum for estimating DALYs due to exposure to environmental and other risks.

General

General procedure

The aim is to analyze current chemical and physical exposures in Finland and their health consequences. The procedures used a similar to a project done in the Netherlands (de Hollander 1999) and the Global burden of disease project of WHO (http://www.who.int/topics/global_burden_of_disease/en/). The work is expected to contribute to a comparative study between Finland, the Netherlands, and Norway (Jantunen: Study plan)

The work will start with selected exposures after which more exposures will be analyzed. The emphasis is on comparability, not comprehensiveness. The selected procedure requires good data on exposure and dose-response, which means that all exposures and all outcomes can not be included.

First, the current exposure distribution is estimated for all Finns (or only those exposed). Based on this exposure distribution and the uncertainties in its estimations, the best guess for the average exposure in Finland (or among those exposed) is estimated together with its uncertainty. The uncertainty in the average exposure is expressed by almost lowest possible (5th percentile) and the almost highest possible (95th percentile) value for the average exposure (i.e. as a distribution, more details below).

To be able to calculate attributable cases, in addition to current average exposure, one needs to determine, which is the lowest feasibly achievable average exposure in Finland. For several substances this is not zero, e.g. there is a natural background for particulate air pollution.

Second, exposure/dose-response functions and their uncertainties (5th and 95th percentiles, as above) are derived for all outcome with sufficient data. It is important that the exposure/dose-response function uses exactly the same exposure/dose marker that was used in the exposure estimation above (more details below).

Third, attributable number of cases is estimated by multiplying the exposure difference with exposure/dose-response and number of exposed using probabilistic methods (Monte-Carlo)

List of potential exposures that could be considered in the evaluation

Criteria 1) Public health effects 2) Concern 3) High exposures in specific groups, e.g. occupational exposures

• Alcohol, metanol
• Particulate air pollution by source
• Ozone
• CO and NO2 (probably included in the above)
• PAHs* Environmental tobacco smoke
• CO indoors
• Benzene* Formaldehyde, naphthalene, hexane, asetaldehyde
• 1,3-butadiene
• Lead
• Damp housing
• Noise* Foodborn epidemics
• Waterborn epidemics
• Chlorination by-products
• Arsenic
• Fluoride
• Dioxin, PCBs, phtalates
• Methyl mercury, mercury
• Radon
• UV radiation
• EMF
• Man-made radiation
• Chemicals in food (acrylamide, pesticides, food additives)
• Accidents (traffic, occupational, domestic/other)

Provisional list of selected exposures and responsible persons

• Radon, STUK/Päivi Kurttio and ?
• Alcohol, STAKES/Timo Ståhl
• Fine particles, KTL/Juha Pekkanen, Olli Leino?
• Dioxins, KTL/Juha Pekkanen, Olli Leino?
• ?Damp housing, KTL/Aino Nevalainen, Ulla Haverinen
• Arsenic, KTL/Hannu Komulainen
• ?Methyl mercury, KTL/Juha Pekkanen, Olli Leino?

Methods

Exposure estimation

Below link to the exposure assessment done for the earlier exposure seminar of our group http://www.ttl.fi/Internet/Suomi/Aihesivut/Kemikaaliturvallisuus/Valittua+kemikaalitietoa/suomaltkemsateil.htm

The following table outlines some occupationally important exposures:

Exposures and dose-responses for selected exposures

Fine particles

Average, population weighted, PM2.5 concentration in Finland: So far we don’t have any available data on fine particles concentrations in Finland. The population average concentration can be estimated to be somewhere between 5 and 10 µg/m3 based on measurements done in Helsinki.

• Population average concentration (mean; min; max): 7.0; 6.0; 8.0

All non-accidental mortality in Finland (year 2000): Mortality counts can be estimated from WHO-mortality database (http://www.who.int/healthinfo/morttables/en/index.html). The number of non-accidental deaths in Finland in year 2000 was 75706.

Concentration-response function for PM2.5 (RR/(10ug/m3)): Based on Pope et al. 2002 study, the relative risk estimate for 10 µg/m3 changes in PM2.5 concentration is 1.06 and 95% confidence interval 1.02 – 1.11.

• Relative risk for PM2.5 (mean; min; max): 1.06; 1.02; 1.11

Threshold value: Current scientific knowledge has not revealed any threshold value for fine particles. For the analysis we use threshold value 5 µg/m3.

• Threshold value: 5 µg/m3

Exposure above threshold: This is the average fine particles exposure above the threshold limit. Estimated by subtracting the threshold from the average exposure.

• Population average concentration above threshold (mean; min; max): 2.0; 1;0; 3.0

Relative risk above threshold: Relative risk estimate for the given exposure. This is estimated from RR-values with formula exp(ln(RR)/10*exposure), that is, for mean estimate exp(ln(1.02)/10*2.0.

• Relative risk above threshold (mean; min; max): 1.01; 1.00; 1:03

Attributable risk above threshold: Percentage change in mortality due to exposure. Estimate from Relative Risk above threshold with formula -> (RR-1)/RR

• Attributable death above threshold (mean; min; max): 1.2%; 0.2%; 3.1%

Number of excess deaths in Finnish population: Mortality with the current information.

• Number of excess deaths in Finnish population (mean; min; max): 877; 150; 2333

The excel sheet with the calculations: http://heande.pyrkilo.fi/heande/images/5/5a/Tainio_Finland.xls