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Your Environment. Your Health.

Estimating the proportion of childhood cancer cases and costs attributable to the environment in California

Environmental Health Economic Analysis Annotated Bibliography

Details

Research article Cost analysis (CA)
Authors
Nelson L, Valle J, King G, Mills PK, Richardson MJ, Roberts EM, Smith D, English P
Journal
American Journal of Public Health
Summary
This cost-analysis estimated the proportion of cases and costs of the most common childhood cancers (leukemia, lymphoma, and brain or other central nervous system cancers) that were attributable to preventable environmental pollution in California in 2013. The authors conducted a literature review to collect risk estimates from studies of childhood cancer associations with preventable environmental pollution for seven hazards, and determined that the combined EAF for these hazards was 15.1% (range = 9.4%–20.7%). The combined annual costs totaled $18.6 million (range = $11.6 million to $25.5 million), and lifetime costs of $31 million. The authors concluded that reducing environmental exposures in California could substantially reduce the human burden of childhood cancer with substantial economic savings.
Population
Children (0-14 years)

Health Outcomes

  • Cancer outcomes (leukemia, lymphoma, brain cancer, central nervous system cancer)

Environmental Agents

List of Environmental Agents:

  • Air pollutants (traffic-related air pollutants, environmental tobacco smoke or secondhand smoke)
  • Ionizing radiation (indoor radon)
  • Volatile organic chemicals (solvents, house paint, and adhesives)
  • Pesticides

Source of Environmental Agents:

  • Tobacco smoke (maternal smoking during pregnancy)
  • Solvents and hydrocarbons (parental exposure to solvents or hydrocarbons around pregnancy, paternal exposure to inhaled hydrocarbons during periconception, mother living in homes painted excessively one year before child's birth, model building in home, artwork using solvents in home)
  • Parental occupational exposure to pesticides via agriculture/farming
  • Residential pesticide exposure (residence on farm or within close proximity of pesticide application during pregnancy or at time of birth, use of insecticides or herbicides in home)
  • Parental occupational exposure to traffic-related air pollution

Economic Evaluation / Methods and Source

Type:

  • Cost analysis (CA)

Cost Measured:

  • Direct medical costs (physician visits, emergency room visits, hospitalizations, prescription medications)
  • Indirect costs (loss of parental or caregiver earnings during hospitalizations)
  • Lifetime costs (lost potential earnings caused by disability or premature death, potential years of life lost as a result of premature mortality)

Potential Cost Measures:

  • Other direct medical costs (over-the-counter medications, transportation for parents or other caregivers)
  • Costs related to school days lost, secondary neoplams, disease reoccurrence
  • Costs for cancers other than leukemia, lymphoma, and brain or CNS cancer
  • Parental health costs related to diagnosis
  • Costs related to diminished quality of life

Benefits Measures: (Not available)

Potential Benefits: (Not available)

Location:

  • California

Models Used:

  • Environmentally attributable fraction (EAF) model The authors don't specify the EAF as a model (per se) in their paper, but it is a very common model/framework applied in these types of studies.

Methods Used:

  • The authors calculated the proportions and costs of childhood cancers among children aged 0 to 14 years that were attributable to preventable environmental exposures in California in 2013. The authors —1) conducted a literature review to identify studies of preventable environmental hazards associated with childhood cancer with evidence for a causal association and available data on the exposure of the population to the hazard; 2) calculated the environmentally attributable factor (EAF) for each cancer type and overall childhood cancer based on reviews of the literature; 3) used hazard-specific EAFs to estimate the proportion of childhood cancer cases in California attributable to the environment; 4) estimated the prevalence of exposure using California survey data, California environmental hazard surveillance data, and estimates from national surveys or individual studies when California data was not available; 5) estimated the annual costs of childhood cancer that included direct medical costs (physician visits, emergency room visits, hospitalizations, prescription medications), indirect costs (loss of parental or caregiver earnings during hospitalizations); and lifetime costs (lost potential earnings caused by disability or premature death).

Sources Used:

  • Environmentally attributable fraction (EAF) (Smith et al., 1999); consensus-based method to estimate EAF for childhood cancer (Landrigan et al., 2002); previously published meta-analyses and/or research studies that met inclusion criteria for selection of environmental hazards; California Cancer Registry (California Department of Public Health, Cancer Surveillance Section, 2017) (http://www.ccrcal.org/Reports_and_Factsheets/Annual_Statistical_Tables_by_Site.shtml); estimates for direct medical costs per case (Trasande and Liu, 2011); mean daily wage of parental earning (Bureau of Labor Statistics, 2017); present value of lifetime production among children aged 0-4 years (Grosse et al., 2009); additional sources cited in publication

Economic Evaluation / Methods and Source

Citation:

  • Nelson L, Valle J, King G, Mills PK, Richardson MJ, Roberts EM, Smith D, English P. 2017. Estimating the proportion of childhood cancer cases and costs attributable to the environment in California. American Journal of Public Health.
  • Pubmed
  • DOI

NIEHS Funding: (Not available)

Other Funding:

  • Centers for Disease Control and Prevention (grant NU38EH000953-06)
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