Dioxin - a Challenge for Burden of Disease Estimation: Results of the EBoDE Project

1. Dioxin - a Challenge for Burden of Disease Estimation: Results of the EBoDE Project Marianne Rappolder, André Conrad, Otto Hänninen, Annette Prüss-Üstün, Anne Knol, MattiJantunen, Olli LeinoOdileMekel, JurgenBuekers, Paolo Carrer, Thomas Classen, IvanoIavarone, Rokho Kim VirpiKollanus, Tek-Ang Lim, Rudi Torfs International HIA 2011 Conference: In crisis times, healthier ways

2. Environmental Burden of Disease in Europe http://en.opasnet.org/w/Ebode Participating countries: Belgium Finland The Netherlands France Germany Italy International HIA 2011 Conference: In crisis times, healthier ways

3. Environmental Stressors OutdoorBenzeneOzoneParticulate Matter (PM10 und PM2,5) Indoor: Radon in buildings Formaldehyde Second hand smoke Noise: Traffic noise Biomonitoring: Lead Food:Dioxins + dioxinlike PCB International HIA 2011 Conference: In crisis times, healthier ways

4. Certaintyoftheassessment High Medium Low Particulate Particulate High air air pollution pollution impact impact (6 000-10 000) (6000 - 10 000) Second hand Traffic noise Radon Noise smoking (500-1100) Dioxins (600 - 800) (1000 - 1500) (600-1200) Lead health health Medium Passive (<500) (100-500) Lead Ozone Dioxins Radon Ozone smoking (40 - 200) (0 - 400) (200 - 400) * (600-900) (300 - 700) (40-200) Public Public Benzene Benzene Formaldehyde Formaldehyde Low (2 - 4) * (0-2) (0 - 2) (2-4) . Overall results Non-discountedvalues DALYs per 1 million people, range of the 6 participating countries International HIA 2011 Conference: In crisis times, healthier ways

5. Data andinformationneeded Fractionofthepopulation, affectedbythe environmental stressor Exposureandpopulationdata Dose-responseofspecific environmental stressor Epidemiology, Toxicology TotalBurdenofDisease(specificendpoints) Environmental BurdenofDisease(specificendpoints) Healthdata International HIA 2011 Conference: In crisis times, healthier ways

6. Dioxins - Introduction Dioxin is not a single chemical Dioxins are always found as a mixture of dioxins and furans Only the seventeen 2,3,7,8 congeners have dioxin-like toxicity with different toxic power, concentration is expressed by Toxic EQuivalence (TEQ) Polychlorinated biphenyls (PCBs) with similar structure have dioxin-like toxicity (from 209 PCB congeners 12 PCBs) - are included in TEQ Daily intake estimation included these chemicals International HIA 2011 Conference: In crisis times, healthier ways

7. Dioxins – exposure Main exposure root is via oral intake: • About 90 % to 95 % of dioxin exposure in men is from food, mainly from animal fat • Dioxins are bio accumulating - half life is 7 to 19 years, stored in fatty tissue (body burden) • Dioxin and PCB contamination in most matrices have been decreased dramatically in the last decades • The body burden increase with age, depends on dioxin contamination in food but also on eating habits and fat content of the body International HIA 2011 Conference: In crisis times, healthier ways

8. Dioxins – dailyintakeestimation Dioxin levels in food • National food monitoring programmes • Food baskets or duplication studies Food Consumption • Food frequency questionnaire • Duplication studies Body burden • Humanbiomonitoring and back-calculation Problems • Dioxin and PCB contamination varies especially in fish (e.g. Finland 0.2-14 pg/g TEQ), • Eating habits differ a lot International HIA 2011 Conference: In crisis times, healthier ways

9. Daily intakeof Dioxins and dl PCBs International HIA 2011 Conference: In crisis times, healthier ways

10. Comparison Human milk – daily intake France was not includied in the WHO-Study The dailyintakefromtheNetherlandsseemedtobeunderestimated International HIA 2011 Conference: In crisis times, healthier ways

11. Exposure - response Unit-risk (UR) approach Cases = f(UR,Exposure) • Dioxins (all cancer) UR = 1*10-3 pro pg/kg/d • All cancer cases are lethal Advantage: absolute number, independent from background disease incidence All other effects (immunotoxic, neurotoxic, toxic for reproduction and development, other endocrine disrupting effects were not considered due to lack of dose-response-function and countable endpoints International HIA 2011 Conference: In crisis times, healthier ways

12. Health effects Prerequisites of quantifyable endpoints: A validated dose-response function Endpoint in humans measurable Data of burden of disease in humans available Problems: Environmental stressors have effects in animal studies Many different effects - difficult to measure and to quantify in humans Epidemiological data are usually from occupational health from mixtures exposure, or by accident International HIA 2011 Conference: In crisis times, healthier ways

13. Results of EBoDE Comparison of Countries DALYs per milionpeopleandcountryfordioxinsanddioxin-like PCBs (undiscounted, un-age-weighted) International HIA 2011 Conference: In crisis times, healthier ways

14. Uncertainties and limitation • Exposuredata (dailyintake): veryhighvariation • Dose-responsefunction: onlyforendpoint „all cancer“ - all otherendpoints not included • DALY-calculationincludesonlymortality (all cancercasesareconsideredtobelethal in thefirstyear • Healtheffect: non cancereffects not considered, e.g. endocrinedisruptingeffectsdifficulttohavequantifyableendpoints International HIA 2011 Conference: In crisis times, healthier ways

15. Conclusion and outlook • DALY fordioxinscouldbeoverestimated (all cancerlethal) orunderestimated(noinclusionof non cancereffects) • DALY-calculationis a suitablemethodforacuteeffects, specificendpoints, lowvariation in exposure • DALY-method is useful for an initial estimation of the impact of a reduction measure for a chemical • Atthis time: limited priorisationof environmental stressorsbased on DALY • Further developing of EBD-Method is needed to take into account: effects of endocrine disruptors, low dose, mixture exposure • Need for better dose responses functions from animal studies International HIA 2011 Conference: In crisis times, healthier ways

16. Thankyouforyourattention! Federal Environment Agency Germany, Berlin Corrensplatz Marianne Rappolder marianne.rappolder@uba.de

17. Measuresfordailyintake International HIA 2011 Conference: In crisis times, healthier ways