Burden of disease, health and population data

For this project, the harmonized health statistics database as held by the World Health Organization was used. This database provides health data specific for each country, health endpoint as defined by the Environmental Burden of Disease -programme, age group and gender. We used data (deaths and DALYs) for the year 2004 (WHO, 2009b; more detailed data available on request)(World Health Organization. The global burden of disease: 2004 update. Geneva: World Health Organization; 2009. Available at: http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html).

The data were obtained in discounted/age-weighted and undiscounted/un-age-weighted format.

Depending on the type of calculation (see section 2.1), different data were needed. For calculations according to methods 1A and 2A (Table 3-19 shows which methods were used for which calculation), the total YLL and YLD were needed per age group and country. The WHO database provides data for pre-defined age categories (e.g. 0–4; 5–14, etc). Age-specific values were derived assuming an equal distribution of people within the age categories in the WHO data. Table 3-15 shows a sample of the burden of disease as available from the WHO database, aggregated over all ages and for a selection of health endpoints only.

For calculations according to method 2B (see section 2.1 and Table 3-19), no background health data was applied; the incidences were calculated using a unit risk model and the burden of disease was estimated using the WHO disability weights and duration estimates. For these calculations (IQ loss and HTD from lead), no age-weighing was applied due to the lack of information on the age distribution of the effects; however, the impact of the simplification was estimated to be small and to affect only the discounted results. Table 3-16 shows the disability weights and durations that were used.

We have carried out preliminary calculations to investigate the potential effect of lag times on the discounted estimates. The lag times used per health endpoint are provided in Table 3-17.

Population data (number of people in 2004) were used to calculate numbers of DALYs per million people and are provided in Table 3-18.

TABLE 3-15. WHO burden of disease data (total undiscounted, not-age-weighted DALYs) in 2004 (sample of health endpoints; aggregated over all ages).

Health endpoint	YLL/ YLD	Burden of disease data (WHO) – discounted (3%) and age-weighted
		Belgium	Finland	France	Germany	Italy	Netherlands
Total mortality (non-violent) Total morbidity	YLL	1 137 042	520 755	5 904 337	9 261 877	5 780 589	1 585 775
	YLD	930 436	460 350	5 219 164	7 283 809	4 838 018	1 360 245
Total cancer	YLL	413 390	154 033	2 447 205	3 193 738	2 215 606	622 914
YLD	34 945	12 796	198 478	254 086	172 230	50 271
Leukaemia	YLL	15 490	5 586	99 669	119 106	93 212	22 131
	YLD	487	167	3 222	3 845	2 859	689
Lung cancers	YLL	103 461	27 142	514 569	653 118	465 809	154 443
	YLD	2 125	583	9 473	12 740	10 014	3 031
Otitis media	YLL	n/a	n/a	n/a	n/a	n/a	n/a
	YLD	1 184	611	7 447	8 038	5 469	2 004
Ischemic heart disease	YLL	178 793	115 258	478 408	1 624 841	841 741	177 269
	YLD	21 764	13 676	56 462	188 782	98 850	22 340
Cardiopulmonary disease	YLL	385 102	203 063	1 222 063	3 067 603	1 861 658	425 443
	YLD	147 553	58 363	502 501	1 003 277	559 717	189 275
Chronic bronchitis	YLL	47 784	9 982	69 644	239 985	134 312	55 767
	YLD	66 091	14 949	125 272	404 043	151 689	83 814
Asthma induction/ aggravation	YLL	4 632	935	17 794	31 851	9 902	1 882
	YLD	13 818	9 264	99 867	100 872	60 658	31 209
Lower respiratory infections	YLL	30 003	13 331	97 589	168 799	78 505	44 596
	YLD	629	361	1 981	3 721	2 317	1 072
Sum of all above	YLL	2 313 816	2 313 816	2 313 816	2 313 816	2 313 816	2 313 816
	YLD	1 220 913	1 220 913	1 220 913	1 220 913	1 220 913	1 220 913
	DALY	3 534 729	3 534 729	3 534 729	3 534 729	3 534 729	3 534 729

TABLE 3-16. Input parameters for calculating the burden of disease (method 2B).

Stressor	Health endpoint	Disability Weight	Duration (yrs)
Lead	Mild mental retardation	0.36	77.6
	Hypertensive disease	0.2	3.6
Road traffic noise	High sleep disturbance (HSD)	0.07a)	1
Railway noise	High sleep disturbance (HSD)	0.07a)	1
Aircraft noise	High sleep disturbance (HSD)	0.07a)	1
Ozone	Minor restricted activity days	0.07b)	0.00274 (= 1 day)
	Cough days, children	0.07b)	0.00274 (= 1 day)
	LRS days in children (excl cough)	0.099c)	0.00274 (= 1 day)
PM2.5	Restricted activity days (RAD)	0.099c)	0.00274 (= 1 day)

^a) Disability weight proposed by the WHO working group for noise impact assessment (confidence intervals 0.04–0.09).

^b) Disability weight for pharyngitis.

^c) Disability weight for lower respiratory infections (chronic sequelae)

TABLE 3-17: Crude estimated lag times (time between exposure to the onset of the disease) as used in the lag-time model (author estimates in years).

Environmental stressor	Health endpoint	Crude estimated lag time (author judgement) years
Benzene	Leukaemia	3
Dioxins	Total cancer incidence	10
SHS	Tracheas, bronchus and lung cancers in non smokers	30
	Ischemic heart disease	3
	Asthma induction, adults (>21 yr)	1
	Asthma induction, children (<14 yr)	1
	Lower respiratory infections (<2 yr)	0
	Otitis media (<3yr)	0
Formaldehyde	Asthma aggravation (children)	0
Lead	IQ loss	3
	Hypertensive disease	1
Transport noise	High sleep disturbance (HSD)	0
	Ischemic heart disease (IHD)	3
Ozone	Total mortality (non-violent)	1
	Minor restricted activity days	0
	Cough days, children	0
	LRS days in children	0
PM2.5	Cardiopulmonary mortality *	3
	Lung cancer mortality *	30
	Total mortality (non-violent) *	3
	Chronic bronchitis	1
	Restricted activity days (RAD)	0
PM10	LRS symptoms days, children	0
	LRS symptom days, adults	0
Radon	Lung cancer	30

* Overlapping end-points.

TABLE 3-18. Population sizes (in 2004; millions) in the defined target population groups (WHO, 2009b: Reference populations and live births).

Populations (in millions)	Belgium	Finland	France	Germany	Italy	Netherlands	Total
All	10.2	5.2	60.6	82.5	58.2	16.3	233.1
Infants (<2 yr)	0.229	0.113	1.530	1.452	1.090	0.399	4.8
Toddlers (<3 yr)	0.345	0.169	2.296	2.197	1.629	0.603	7.2
Children (0-4 yr)	0.58	0.28	3.83	3.69	2.71	1.02	12.1
School children (5–14 yr)	1.23	0.63	7.39	8.35	5.51	2.00	25.1
Children (<14 yr)	1.7	0.851	10.5	11.2	7.7	2.8	34.6
Adults (>15 yr)	8.4	4.3	49.4	70.5	50.0	13.3	195.8
Adults (>15 yr) with chronic LRS *	2.5	1.3	14.8	21.1	15.0	4.0	58.8
Non-smoking adults (>15 yr)	6.3	3.2	35.3	50.0	38.2	8.8	141.9
Adults (>21 yr)	7.7	3.9	44.7	64.7	46.4	12.1	179.6
Adults (>27 yr)	6.9	3.5	40.0	58.9	42.2	10.9	162.5
Adults (>30 yr)	6.5	3.3	37.8	56.1	39.8	10.3	153.8
Adults (15-64 yr)	6.7	3.5	39.5	55.4	38.7	11.0	154.7
Working age (18–64 yr)	6.3	3.3	37.1	52.5	37.0	10.4	146.7

* Adults with chronic respiratory symptoms estimated in CAFE to be 30% (Watkiss et al, 2005).