dioxin - a challenge for burden of disease estimation: results of the ebode project

Dioxin - a Challenge for Burden of Disease Estimation:

Results of the EBoDE Project

International HIA 2011 Conference: In crisis times, healthier ways

Marianne Rappolder, André Conrad, Otto Hänninen, Annette Prüss-Üstün, Anne Knol, Matti Jantunen, Olli Leino Odile Mekel, Jurgen Buekers, Paolo Carrer, Thomas Classen, Ivano Iavarone, Rokho Kim Virpi Kollanus, Tek-Ang Lim, Rudi Torfs

Environmental Burden of Disease in Europe

Participating countries:Belgium

Finland

The Netherlands

France

Germany

Italy

15 April 2011 2International HIA 2011 Conference: In crisis times, healthier ways

http://en.opasnet.org/w/Ebode

Environmental Stressors


Outdoor Benzene OzoneParticulate Matter (PM10 und PM2,5)

Indoor: Radon in buildings Formaldehyde Second hand smoke

Noise: Traffic noise

Biomonitoring: Lead

Food: Dioxins + dioxin like PCB

4

Overall results

Publ

iche

alth

impa

ct

Particulateair pollution

(6000- 10 000)

Passivesmoking

(300- 700)

Noise(1000- 1500)

Lead(200- 400)*

Ozone(40- 200)

Radon(600- 800)

Dioxins(0- 400)

Formaldehyde(0- 2)*

Benzene(2- 4)

.

High

Medium

Low

Certainty of the assessment

High Medium Low

Publ

iche

alth

impa

ct

Particulateair pollution

(6 000-10 000)

Second handsmoking

(600-900)

Traffic noise(500-1100)Lead

(100-500)

Ozone(40-200)

Radon

(600-1200) Dioxins(<500)

Formaldehyde(0-2)

Benzene(2-4)

DALYs per 1 million people, range of the 6 participating countries

15 April 2011 International HIA 2011 Conference: In crisis times, healthier ways

Non-discounted values

5

Data and information needed


Fraction of the population, affected by the environmental stressor

TotalBurden of Disease(specific endpoints)

Environmental Burden of Disease(specific endpoints)

Dose-response of specific environmental stressor

Exposure and population data

Epidemiology, Toxicology

Health data

Dioxins - Introduction


Dioxin is not a single chemical• Dioxins are always found as a mixture of dioxins and

furans• Only the seventeen 2,3,7,8 congeners have dioxin-like

toxicity with different toxic power, concentration is expressed by Toxic EQuivalence (TEQ)

• Polychlorinated biphenyls (PCBs) with similar structure have dioxin-like toxicity (from 209 PCB congeners 12 PCBs) - are included in TEQ

• Daily intake estimation included these chemicals

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Dioxins – exposure

Main exposure root is via oral intake:

• About 90 % to 95 % of dioxin exposure in men is from food, mainly from animal fat

• Dioxins are bio accumulating - half life is 7 to 19 years, stored in fatty tissue (body burden)

• Dioxin and PCB contamination in most matrices have been decreased dramatically in the last decades

• The body burden increase with age, depends on dioxin contamination in food but also on eating habits and fat content of the body


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Dioxins – daily intake estimationDioxin levels in food• National food monitoring programmes• Food baskets or duplication studiesFood Consumption• Food frequency questionnaire• Duplication studiesBody burden• Humanbiomonitoring and back-calculation

Problems• Dioxin and PCB contamination varies especially in fish

(e.g. Finland 0.2-14 pg/g TEQ), • Eating habits differ a lot


Daily intake of Dioxins and dl PCBs

15 April 2011 9

Countries Population group Source Sampling

yearDioxin intake pg/kg bw/d

Belgium adults-fem.18-44 y

adults 50-65 yAdults - mean

Bilau 2008Bilau 2008Calculated

2002-062.091.74

1.9 (mean) Finland all Kiviranta et al

2005 2002 1.5

France 30-65 y Fréry et al. 2006 2004 2.3

Germany adults UBA 2005 2003 2.0

Italy 13 – 94 y Fattore et al 2006 1997-2003 2.3

Netherlands adults De Mul 2008 2004 1.0


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Comparison Human milk – daily intake

France was not includied in the WHO-Study

The daily intake from the Netherlands seemed to be underestimated


Country Human milk

Daily intake

factor

ng TEQ/kg fat

ng TEQ/kg bw/d

Milk/intake

Belgium 29.5 1.9 16Finland 15.3 1.5 10Germany 26.2 2.0 13Italy 29.0 2.3 13Netherlands 29.8 1.0 30

0

5

10

15

20

25

30

35B

elgi

um

Finl

and

Ger

man

y

Italy

Net

herla

nds

Spa

in

ng W

HO-T

EQ/k

g fa

t (TE

F 19

98)

dl PCB

PCDD/F

Exposure - response


Unit-risk (UR) approachCases = f(UR,Exposure)

• Dioxins (all cancer) UR = 1*10-3 pro pg/kg/d• All cancer cases are lethal

Advantage: absolute number, independent from background disease incidence

All other effects (immunotoxic, neurotoxic, toxic for reproduction and development, other endocrine disrupting effects were not considered due to lack of dose-response-function and countable endpoints

–

Health effects


Prerequisites of quantifyable endpoints:• A validated dose-response function• Endpoint in humans measurable• Data of burden of disease in humans available

Problems:• Environmental stressors have effects in animal studies• Many different effects - difficult to measure and to

quantify in humans• Epidemiological data are usually from occupational health

from mixtures exposure, or by accident

Results of EBoDE


Comparison of Countries

DALYs per milion people and country for dioxinsand dioxin-like PCBs (undiscounted, un-age-weighted)

Uncertainties and limitation


• Exposure data (daily intake): very high variation

• Dose-response function: only for endpoint „all cancer“ - all other endpoints not included

• DALY-calculation includes only mortality (all cancer cases are considered to be lethal in the first year

• Health effect: non cancer effects not considered, e.g. endocrine disrupting effects difficult to have quantifyable endpoints

Conclusion and outlook


• DALY for dioxins could be overestimated (all cancer lethal) or underestimated (no inclusion of non cancer effects)

• DALY-calculation is a suitable method for acute effects, specific endpoints, low variation in exposure

• DALY-method is useful for an initial estimation of the impact of a reduction measure for a chemical

• At this time: limited priorisation of environmental stressors based on DALY

• Further developing of EBD-Method is needed to take into account: effects of endocrine disruptors, low dose, mixture exposure

• Need for better dose responses functions from animal studies

Thank you for your attention!

Marianne [email protected]

Federal Environment Agency Germany, Berlin Corrensplatz

Measures for daily intake

15 April 2011 17

Type of measurement Type of use Specific limitations and uncertainties

A Survey (questionnaire) on food consumption

Information on food consumption and about the content of dioxins in representative food samples allow modelling of daily intake

Results are modelled for an average population - food contamination and eating habits can differ on a large scale

B Total diet studies The total diet in a population group over a certain time period and dioxin in this food or representative food samples are measured.

Results are only relevant for the investigated groups and not necessarily representative for the whole population, sampling period influence the results.

C Humanbiomonitoring Investigation of human milk or blood levels

Analyses of samples can show the body burden. Experimental scaling is used to convert observed biomonitoring results (blood) into daily intakes.

D-R function is based on daily intake. It had to calculate from body burden. Human milk or blood samples are not widely available. Different fat content of the bodies influences the results.


dioxin - a challenge for burden of disease estimation: results of the ebode project

Documents

crisis times

dioxins dioxin

healthier ways http

burden of disease estimation

ebode projectinternational

environmental stressors15

traffic noisebiomonitoring

traffic noise5001100lead100