Burden of disease attributable to selected environmental factors and injury among children and adolescents in Europe

doi:10.1016/S0140-6736(04)16452-0

The Lancet

Volume 363, Issue 9426, 19 June 2004, Pages 2032-2039

https://doi.org/10.1016/S0140-6736(04)16452-0 Get rights and content

Summary

Background

Environmental exposures contribute to the global burden of disease. We have estimated the burden of disease attributable to outdoor and indoor air pollution, inadequate water and sanitation, lead exposure, and injury among European children and adolescents.

Methods

Published studies and reports from international agencies were reviewed for calculation of risk-factor exposure in Europe. Disability-adjusted life years (DALYs) or deaths attributable to each factor, or both, were estimated by application of the potential impact fraction to the estimates of mortality and burden of disease from the WHO global database of burden of disease.

Findings

Among children aged 0–4 years, between 1·8% and 6·4% of deaths from all causes were attributable to outdoor air pollution; acute lower-respiratory-tract infections attributable to indoor air pollution accounted for 4·6% of all deaths and 3·1% of DALYs; and mild mental retardation resulting from lead exposure accounted for 4·4% of DALYs. In the age-group 0–14 years, diarrhoea attributable to inadequate water and sanitation accounted for 5·3% of deaths and 3·5% of DALYs. In the age-group 0–19 years, injuries were the cause of 22·6% of all deaths and 19·0% of DALYs. The burden of disease was much higher in European subregions B and C than subregion A. There was substantial uncertainty around some of the estimates, especially for outdoor air pollution.

Interpretation

Large proportions of deaths and DALYs in European children are attributable to outdoor and indoor air pollution, inadequate water and sanitation, lead exposure, and injuries. Interventions aimed at reducing children's exposure to environmental factors and injuries could result in substantial gains. The pronounced differences by subregion and age indicate the need for targeted action.

Introduction

Concern about the effects on children's health of unsafe and unhealthy environments and a commitment to action has lately been expressed at international level.¹ The concern stems from increasing evidence that children are especially susceptible and may be more exposed than adults to many adverse environmental factors including: unsafe home environments; road traffic; chemical and microbiological contamination of air, water, food, and soil; and physical agents such as radiation and noise.2, 3 Worldwide, an estimated 40% or more of the environmental burden of disease (EBD) falls on children under 5 years of age.⁴

Generally, children living in the 51 countries of the WHO European region enjoy better health than those living in other regions, but they are not exempt from the effects of unsafe and unhealthy environments. Furthermore, poverty, a powerful determinant of environmental exposure, affects a substantial proportion of children in the region.⁵ Although there is increasing evidence on the association between children's exposure to environmental toxicants and health effects,³ the magnitude and geographical distribution of EBD among children (0–19 years) in the WHO European region have not been assessed so far.

To provide the knowledge base for the development of the children's environment and health action plan for the European region (CEHAPE), which will be discussed and negotiated at the Fourth Ministerial Conference on Environment and Health to be held in Budapest, Hungary, in June, 2004,⁶ we assessed the EBD in terms of deaths and disability-adjusted life years (DALYs)7, 8 among children and adolescents. Our assessment was restricted to four major environmental risk factors (outdoor air pollution, indoor air pollution, inadequate water and sanitation, and lead) and injuries, which represent the main environmental risk factors globally⁹ and for which available data are sufficient for large-scale estimates.

Section snippets

Methods

The methods of the study and data sources10, 11, 12, 13, 14, 15 are summarised in Table 1.

Results

Children's exposures to the main environmental factors by subregion are reported in Table 2. Children in subregions EurB and EurC had greater exposure to outdoor and indoor air pollution, inadequate water and sanitation, and lead than children in EurA.

In the European region as a whole, we estimated that in the age-group 0–4 years, 6·4% of all deaths (or 1·8% by application of the relative risk for outdoor air pollution to deaths due to acute respiratory-tract infections only) are attributable

Discussion

Our study provides an assessment of the effect of environmental factors on children's health in the European region. A limited number of environmental factors and disease outcomes were included in the analyses, owing to the lack of valid exposure data and strong evidence of exposure–response relations. For example, lack of safe water and sanitation and air pollution contribute to undernutrition and chronic respiratory disease,⁴ but these disease outcomes could not be included in the analysis.

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ArticlesBurden of disease attributable to selected environmental factors and injury among children and adolescents in Europe

Summary

Background

Methods

Findings

Interpretation

Introduction

Section snippets

Methods

Results

Discussion

Regulat Toxicol Pharmacol

Lancet

Environ Res

Declaration of the Third Ministerial Conference on Environment and Health (London; June 16–18, 1999)

How much global ill health is attributable to environmental factors?

Epidemiology

The State of the World's children

Fourth Ministerial Conference on Environment and Health, Budapest, Hungary

The global burden of disease

Introduction and methods: assessing the environmental burden of disease at national and local levels

Air pollution data by region and country. The World Bank, Development Economics research Group Estimates

Burden of Disease project: 2001 mortality and DALYs

Estimating the burden of disease from water, sanitation, and hygiene at a global level

Environ Health Perspect

List of Member States by WHO Region and Mortality Stratum

Air pollution and child mortality: a time-series study in Sao Paulo, Brazil

Environ Health Perspect

Air pollution and infant mortality in Mexico City

Epidemiology

Indoor smoke from solid fuels: assessing the environmental burden of disease at national and local levels

Prevention of diarrhoea in young children in developing countries

Bull World Health Organ

Articles
Burden of disease attributable to selected environmental factors and injury among children and adolescents in Europe