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Your Environment. Your Health.

Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost analysis (CA)
Landrigan PJ, Schechter CB, Lipton JM, Fahs MC, and Schwartz J
Environmental Health Perspectives
This analysis estimated the economic costs associated with four categories of pediatric illness attributable to environmental factors (lead poisoning, asthma, cancer, and neurodevelopmental conditions) to be an annual total of $54.9 billion, or 2.8 %, of total U.S. health care costs. This study represented the first comprehensive attempt to estimate the incidence, prevalence, mortality, and costs associated with pediatric disease of toxic environmental origin in the United States.
Children (≤ 5 years)

Health Outcomes

  • Lead poisoning
  • neurobehavioral outcomes
  • respiratory outcomes (asthma)
  • cancer outcomes (childhood cancer)

Environmental Agents

List of Environmental Agents:

  • Metals (lead)
  • air pollutants (particulate matter)

Source of Environmental Agents:

  • Nonbiologic air pollutants (vehicle exhaust, emissions from stationary sources)
  • source not available for metal (lead) exposure

Economic Evaluation / Methods and Source


  • Cost analysis (CA)

Cost Measured:

  • Medical/healthcare costs (hospital care/hospitalization, physician services, medications, laboratory services
  • costs of long-term care (therapy/rehabilitation)
  • indirect costs (lifetime earnings, lost productivity, lost school days, premature deaths, IQ reduction, loss of parental wages)
  • investigators also considered effects of cranial irradiation on IQ reduction (treatment for childhood brain cancer)

Potential Cost Measures:

  • Costs related to pain, suffering and/or late complications
  • costs for outcomes related to tobacco, alcohol or drug abuse

Benefits Measures: (Not available)

Potential Benefits: (Not available)

Location: (Not available)

Models Used:

  • Environmentally Attributable Fraction (EAF) model
  • economic forecasting model

Methods Used:

  • The authors estimated the contribution of environmental pollutants to the incidence, prevalence, mortality, and costs of pediatric disease in American children. The authors — 1) used disease-specific methodologies to estimate the costs for each type of health outcome; 2) estimated costs by calculating the environmentally attributable fraction (EAF) of each type of health outcome, multiplying by the disease rate and population size, and by the cost per case; 3) retrieved data on costs, prevalence, incidence, and morbidity for health outcomes from a variety of relevant sources; and 4) developed EAFs using a modified Delphi technique with a panel of experts.

Sources Used:

  • US EPA; Asthma surveillance data (CDC, 1960-1995); Lead poisoning prevalence and blood lead levels data (CDC, 1991-1994); National Health Interview Survey (National Center for Health Statistic, 1994); SEER database (National Cancer Institute, 1995); US Census Bureau (1990-2000); US Bureau of Labor Statistics (1999); Health Care Financing Administration (1995-2000); Pediatric malignancies data (Mount Sinai Medical Center, 1992-1997); Practice Management Information Corporation (1995); additional sources cited in publication

Economic Evaluation / Methods and Source


  • Landrigan PJ, Schechter CB, Lipton JM, Fahs MC, and Schwartz J. 2002. Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities. Environmental Health Perspectives.
  • Pubmed
  • DOI: (Not available)

NIEHS Funding: (Not available)

Other Funding: (Not available)

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