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Your Environment. Your Health.

Population attributable risks and costs of diabetogenic chemical exposures in the elderly

Environmental Health Economic Analysis Annotated Bibliography


Research Article Cost benefit analysis (CBA)
Trasande L, Lampa E, Lind L, Lind PM
Journal of Epidemiology and Community Health
This cost-benefit analysis examined potential reductions in diabetes cases and related costs from reduced exposure of elderly people to endocrine-disrupting chemicals (EDCs) in Europe. The authors calculated that a 25% reduction in exposure to four EDCs combined was associated with a 13% reduction in diabetes in the elderly. They found that the reductions would prevent 152,481 cases of diabetes and save €4.51 billion per year in associated costs. The authors suggested that healthcare providers advise patients to reduce their exposures, and regulatory agencies consider strategies to reduce exposures
Men and women aged 70-75 years

Health Outcomes

  • Metabolic outcomes (diabetes, increased body mass index)

Environmental Agents

List of Environmental Agents:

  • Hormonal mimics (phthalates, monoethylphthalate (MEP))
  • Chlorinated compounds (4',5,5'-hexachlorobiphenyl (PCB 153))
  • Fluorinated compounds (perfluorononanoic acid (PFNA))
  • Pesticide compounds (dichlorodiphenyldichloroethylene (p,p'-DDE))

Source of Environmental Agents: (Not available)

Economic Evaluation / Methods and Source


  • Cost benefit analysis (CBA)

Cost Measured:

  • Annual cost estimate for diabetes per adult aggregated over 10 years

Potential Cost Measures: (Not available)

Benefits Measures:

  • Annual costs of diabetes prevented with a 25% decrease in exposure to each of the four compounds individually and with a 25% decrease in all four compounds

Potential Benefits: (Not available)


  • Uppsala, Sweden

Models Used:

  • Poisson regression models

Methods Used:

  • The authors calculated benefits associated with a 25% reduction in exposures to four chemicals in the elderly. The authors — 1) used previously collected biomonitoring exposure data of chemical concentrations in plasma and serum from a Swedish cohort of 1,016 elderly people; 2) used Poisson regression models for calculations including independent variables of exposure levels of each of the four contaminants, sex, body mass index, physical activity, daily energy intake, and daily alcohol intake; 3) calculated the population attributable fractions (PAFs) based on the attribrisk function in the R-package statistical analysis program; 4) developed five models with one for each scenario tested (25% decrease in exposure to all four chemicals combined, and a 25% decrease in exposure to each compound individually); and 5) used bootstrap to construct 95% bias corrected and accelerated confidence intervals for PAF using 10,000 replicates.

Sources Used:

  • Annual cost estimates for diabetes per adult in 2010 (Zhang et al., 2010); previously collected data from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) cohort study (Lind et al., 2005; Lind and Lind, 2012; Lind et al., 2014; Lind et al, 2012; Lee et al, 2011); age-standardized prevalence of diabetes in Europe (European Commission, 2010); additional sources cited in the publication

Economic Evaluation / Methods and Source


  • Trasande L, Lampa E, Lind L, Lind PM. 2017. Population attributable risks and costs of diabetogenic chemical exposures in the elderly. Journal of Epidemiology and Community Health.
  • Pubmed
  • DOI

NIEHS Funding: (Not available)

Other Funding: (Not available)

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