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Philip J. Landrigan, ^1,2 Clyde B. Schechter, ² Jeffrey M. Lipton,³ Marianne C. Fahs,⁴ and Joel Schwartz⁵

¹The Center for Children's Health and the Environment, ²The Department of Community and Preventive Medicine, and ³The Department of Pediatrics, Mount Sinai School of Medicine, New York, New York, USA; ⁴The Health Policy Research Center, New School for Social Research, New York, New York, USA; and ⁵The Environmental Epidemiology Program, Harvard School of Public Health, Boston, Massachusetts, USA

Abstract

In this study, we aimed to estimate the contribution of environmental pollutants to the incidence, prevalence, mortality, and costs of pediatric disease in American children. We examined four categories of illness: lead poisoning, asthma, cancer, and neurobehavioral disorders. To estimate the proportion of each attributable to toxins in the environment, we used an environmentally attributable fraction (EAF) model. EAFs for lead poisoning, asthma, and cancer were developed by panels of experts through a Delphi process, whereas that for neurobehavioral disorders was based on data from the National Academy of Sciences. We define environmental pollutants as toxic chemicals of human origin in air, food, water, and communities. To develop estimates of costs, we relied on data from the U.S. Environmental Protection Agency, Centers for Disease Control and Prevention, National Center for Health Statistics, the Bureau of Labor Statistics, the Health Care Financing Agency, and the Practice Management Information Corporation. EAFs were judged to be 100% for lead poisoning, 30% for asthma (range, 10-35%) , 5% for cancer (range, 2-10%) , and 10% for neurobehavioral disorders (range, 5-20%) . Total annual costs are estimated to be $54.9 billion (range $48.8-64.8 billion) : $43.4 billion for lead poisoning, $2.0 billion for asthma, $0.3 billion for childhood cancer, and $9.2 billion for neurobehavioral disorders. This sum amounts to 2.8 percent of total U.S. health care costs. This estimate is likely low because it considers only four categories of illness, incorporates conservative assumptions, ignores costs of pain and suffering, and does not include late complications for which etiologic associations are poorly quantified. The costs of pediatric environmental disease are high, in contrast with the limited resources directed to research, tracking, and prevention. Key words: asthma, cancer, developmental disabilities, environmental pediatrics, health economics, lead poisoning. Environ Health Perspect 110:721-728 (2002) . [Online 31 May 2002]

http://ehpnet1.niehs.nih.gov/docs/2002/110p721-728landrigan/ abstract.html

Address correspondence to P.J. Landrigan, Mount Sinai School of Medicine, Department of Community and Preventive Medicine, Box 1057, One Gustave L. Levy Place, New York, NY 10029-6574, USA. Telephone: (212) 241-4804. Fax: (212) 996-0407. E-mail: phil.landrigan@mssm.edu

The authors acknowledge the generous advice provided by our three expert review panels: Lead Poisoning: J. Schwartz, H.L. Needleman, M.S. Kamlet ; Asthma: M. Lippmann, P.J. Gergen, D.W. Dockery, M. Kattan ; Cancer: J.C. Bailar III, S.H. Zahm, L.L. Robison, J.M. Peters. We also thank our Project Advisory Committee: K. Arrow, S.H. Gehlbach, and J. Schwartz.

This work was supported by a grant from the W. Alton Jones Foundation and by the Mount Sinai Center for Children's Health and the Environment, a project supported by The Pew Charitable Trusts.

Received 2 November 2001 ; accepted 18 February 2002.