Table 3

Overview of available disease burden estimates attributable to chemicals

Chemicals/Groups of chemicals

Disease outcomes considered (attributable fraction)

Deaths

DALYs^‡

Main limitations¤

Data year/method^§

Chemicals in acute poisonings

526,000 (sub-total)

9,666,000 (sub-total)

Chemicals (including drugs) involved in unintentional acute poisonings (methanol, diethylene glycol, kerosene, pesticides etc.)

Unintentional poisonings (71%)

240,000^a

5,246,000^a

Limited to preventable poisonings. Total unintentional poisonings would amount to 346,000 deaths and 7,445,000 DALYs[12]

2004; C [13]^b

Chemicals involved in unintentional occupational poisonings

Unintentional poisonings (occupational) (8.6%)

30,000^c

643,000^c

-

2004; A [14]

Pesticides pesticides involved in self-inflicted injuries

Self-inflicted injuries (23%)

186,000

4,420,000

Limited to preventable self inflicted injuries. Impact of accidental and chronic exposures not considered.

2002; C [13]

Chemicals in occupational exposures (longer term effects)

581,000 (sub-total)

6,763,000 (sub-total)

Asbestos

Malignant mesothelioma (NA); trachea, bronchus, lung cancer (0.3%); asbestosis (NA)

107,000^d

1,523,000^d

-

2004; A [14]^, [50]

Occupational lung carcinogens (arsenic, asbestos, beryllium, cadmium, chromium, diesel exhaust, nickel, silica)

Trachea, bronchus, lung cancer (8.6%)

111,000

1,011,000

Only 8 of the chemicals or chemical mixtures classified as carcinogenic or probably carcinogenic to humans taken into account

2004; A [14]

Occupational leukaemogens (benzene, ethylene oxide, ionizing radiation)

Leukaemia (2.3%)

7,400^e

113,000^e

Only 2 of the chemicals or chemical mixtures classified as carcinogenic or probably carcinogenic to humans taken into account

2004; A [14]

Occupational particulates - causing COPD (dusts, fumes/gas)

COPD (13%)

375,000^f

3,804,000^f

-

2004; A [14]

Occupational particulates - other respiratory diseases than COPD (silica, asbestos and coal mine dust)

Asbestosis (NA); silicosis (NA); pneumoconiosis (NA)

29,000

1,062,000

-

2004; A [14]

Air pollutant mixtures

3,720,000 (sub-total)

60,669,000 (sub-total)

Outdoor air pollutants (particulate matter, sulfur dioxide, nitrogen oxides, benzo[a]pyrene, benzene, others)

Lung cancer (7.9%); acute respiratory infections (1.6%); selected cardiopulmonary diseases (3.4%)

1,152,000

8,747,000

Only urban air pollution in cities with >100 000 inhabitants taken into account. Health impact from rural air pollution unknown.

2004; A [14]

Outdoor air pollutants emitted from ships (particulate matter, sulfur dioxide, nitrogen oxides, benzo[a]pyrene, benzene, others)

Lung cancer (0.3%); selected cardiopulmonary diseases (0.4%)

60,000^g

NA

-

2002; B [95]

Indoor air pollutants from solid fuel combustion (carbon monoxide, nitrogen oxides, sulfur oxides, benzene, formaldehyde, polyaromatic compounds, particulates, others)

Lung cancer (2.9%); acute respiratory infections (33%); COPD (33%)

1,965,000

41,009,000

Disease burden from emissions from building materials and household products is not know. BoD from second hand smoke has been evaluated separately.

2004; A [14]

Second-hand smoke (nicotine, formaldehyde, carbon monoxide, phenols, nitrogen oxides, naphthalenes, tar, nitrosamine, PAHs, vinyl chloride, various metals, hydrogen cyanide, ammonia, others)

Lower respiratory infections (6.3%); otitis (1.7%); asthma (11%); lung cancer (1.8%); ischaemic heart disease (4.5%)

603,000

10,913,000

-

2004; B [29]

Single chemicals with mostly longer term effects

152,000 (sub-total)

9,102,000 (sub-total)

Lead

Mild mental retardation; Cardiovascular diseases

143,000

8,977,000

-

2004; A [14]

Arsenic in drinking-water

Diabetes mellitus (0.04%) ischemic heart disease (0,11%); lung cancer (0.25%); bladder cancer (1.2%); kidney cancer (NA); skin cancer (0.30%)

9,100^a

125,000^a

Limited to exposure through drinking water. Limited to Bangladesh.

2001; B [11]

Total ^#,h Total in children <15 years

All considered diseases

4,879,000 (8.3%) 1,073,000 (22%)

86,200,000 (5.7%) 46,627,000 (54%)

Mainly 2004; A

^‡ DALYs are "Disability-adjusted life years", a weighted measure of years of life lost due to premature death, and years lived with disability. ¤ Only outcomes qualified as strong evidence were considered. ^§ Methods: A: Comparative Risk Assessment (CRA); B: Based on exposure and exposure-response (similar to CRA); C: Evidence synthesis and expert evaluation. ^# The estimates were developed within three years and their pooling is unlikely to introduce a significant error. NA: not available. -: none.

^a Estimate not compared to counterfactual exposure, which is however estimated to be negligible using a theoretical minimum exposure given available management options for concerned chemicals.

^b Values updated for 2004 based on original reference.

^c Already included in total unintentional acute poisonings and therefore not included again in the total.

^d Lung cancer and asbestosis caused by asbestos are also considered in occupational lung carcinogens and particulates and this part of the burden is therefore not counted twice in the total.

^e Also includes a small fraction of leukaemia caused by ionizing radiation.

^f Parts of the particulates are organic in nature, and the estimate therefore includes a small fraction that is not or not directly related to chemicals

^g Overlaps with the burden from outdoor air pollution and is therefore not included in the total.

^h Total is corrected for double counting (chemicals considered in more than one estimate); not all disease burdens are however additive, and joint exposures could lead to slight overestimate (see Methods section).

Prüss-Ustün et al. Environmental Health 2011 10:9   doi:10.1186/1476-069X-10-9