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Your Environment. Your Health.

Racial/ethnic disparities in disease burden and costs related to exposure to endocrine disrupting chemicals in the US: an exploratory analysis

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost analysis (CA)
Attina TM, Malits J, Naidu M, Trasande L
Journal of Clinical Epidemiology
In this cost-analysis study, authors quantified disease burden and associated costs for specific EDCs in a representative sample of the United States population according to race/ethnicity. They found that EDC exposure levels and associated burden of disease and crude costs were higher in racial/ethnic minorities in proportion to their respective populations. For example, associated burden of disease and costs were higher in non-Hispanic black people ($56.8 billion; 16.5% of total costs) and Mexican Americans ($50.1 billion; 14.6%) compared with their proportion of the total population (12.6% and 13.5%, respectively). Findings suggest that these disparities are driven by generally higher exposure to persistent pesticides and flame retardants among non-Hispanic black people and Mexican Americans. The authors concluded that racial/ethnic disparities for chronic diseases in the United States may be due to chemical exposures; therefore, these cost estimates are an important tool to inform policies that address such disparities.
Representative sampling of the United States population (ages not specified)

Health Outcomes

  • Neurological/cognitive outcomes (lowering of IQ, intellectual disability)
  • Metabolic outcomes (adult obesity, childhood obesity, adult diabetes)
  • Cancer outcomes (testicular cancer)
  • Cardiovascular outcomes (early cardiovascular mortality due to reduced testosterone)
  • Reproductive outcomes (leiomyomas, endometriosis)
  • Birth outcomes (cryptochordism)

Environmental Agents

List of Environmental Agents:

  • Brominated compounds (polybrominated diphenyl ethers (PBDEs))
  • Chlorinated compounds (dioxin (1,1-dichloro-2,2-bis (p-chlorophenyl) ethylene (DDE)))
  • Pesticides (organophosphate pesticides)
  • Hormonal mimics (bisphenol A (BPA), phthalates)

Source of Environmental Agents: (Not available)

Economic Evaluation / Methods and Source


  • Cost analysis (CA)

Cost Measured:

  • Cost of illness per case for each health outcome by aggregating previously published cost estimates to calculate overall costs (direct and indirect costs), additional medical expenditures in childhood and adulthood due to obesity, lost disability-adjusted life years (DALYs) due to obesity, annual costs for diabetes, lifetime economic productivity loss due to death, direct costs of medical and surgical management of uterine fibroids, healthcare costs and lost DALYs due to endometriosis

Potential Cost Measures: (Not available)

Benefits Measures: (Not available)

Potential Benefits: (Not available)


  • United States

Models Used:

  • Environmentally attributable fraction (EAF) model

Methods Used:

  • The authors calculated disease burden and associated costs by racial/ethnic group in the United States attributable to endocrine-disrupting chemicals (EDCs). The authors – 1) used biomonitoring data from the National Health and Nutrition Examination Surveys (2007-2010) that contains biomonitoring data for the EDCs being studied by race and ethnicity; 2) used exposure-response relationship data from previously published studies to estimate burdens of disease; 3) estimated total costs using a cost of illness approach that aggregated total costs incurred due to each disease/condition; and 4) calculated the economic cost disparities using a counterfactual model to determine total costs of each health outcome by racial/ethnic group as a proportion of the total population.

Sources Used:

  • Human biomonitoring data from the United States Centers for Disease Control and Prevention (CDC)'s National Health and Nutrition Examination Surveys (NHANES), using the 2007-2008 survey for PBDEs, DDE, and organophospate pesticide monitoring, and the 2009-2010 survey for BPA and phthalates; costs per case derived from previously published estimates of per case direct or indirect costs and used to calculate overall costs, adjusted to 2010 using the Medical Care Consumer Price Index (Bureau of Labor Statistics, 2016); previously published models to quantify disease burden among racial/ethnic groups of interest (Hicken et al., 2012; Hodgson et al., 1982); CDC Wonder database for conversion of prevalence/incidence to appropriate population size according to race/ethnicity (Jennings et al., 2017); exposure-response relationship data (Trasande et al., 2015; Hunt et al., 2016); cost of illness approach (Hodgson et al., 1982); additional sources cited in publication

Economic Evaluation / Methods and Source


  • Attina TM, Malits J, Naidu M, Trasande L. 2018. Racial/ethnic disparities in disease burden and costs related to exposure to endocrine disrupting chemicals in the US: an exploratory analysis. Journal of Clinical Epidemiology.
  • Pubmed
  • DOI

NIEHS Funding: (Not available)

Other Funding: (Not available)

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