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ReferencesHiligsmann, M., Gathon, H. J., Bruyere, O., Daubie, M., Parmentier, Y., Dercq, J. P. et al. (2011). Hospitalisation costs of hip fractures in Belgium. Osteoporosis International 22: 332-332.Nawrot, T., Plusquin, M., Hogervorst, J., Roels, H. A., Celis, H., Thijs, L. et al. (2006). Environmental exposure to cadmium and risk of cancer: a prospective population-based study. Lancet Oncology 7(2): 119-126.Staessen, J. A., Roels, H. A., Emelianov, D., Kuznetsova, T., Thijs, L., Vangronsveld, J. et al. (1999). Environmental exposure to cadmium, forearm bone density, and risk of fractures: prospective population study. Lancet 353(9159): 1140-1144.
3. Case study
• Campine region (brown area) in Belgium• Heavy metal pollution due to zinc smelters• No more Cd emissions since 1980s
Results from earlier epidemiologic research:• Higher Cd body burden in high exposure areas (HEA) • Increased relative risk (RR) of osteoporotic fractures (Staessen
et al., 1999) and lung cancer (Nawrot et al., 2006)
6. Conclusion
• More than €500,000 per year in medical costs due to pollution• Pollution flow has stopped since 1980s, 20-25 years ago pollution causes long lasting health and economic burden• Contribution of soil Cd to body burden is relatively small PA illnesses are expected to decrease in the future
Assumptions and restrictions• Conservative economic estimate• RR have remained constant over the years
Epidemiologic research• Objective: Identify impact of environmental
pollution on human health• Method: Cohort study (Staessen et al., 1999;
Nawrot et al., 2006)
Health risk assessment• Objective: Determine pollution-attributable (PA)
illnesses on the population level• Method: Exposure assessment
Health economic analysis• Objective: Assess economic burden as a result
of PA illnesses• Method: Cost of Illness (COI)
Economic impact assessment of environmental contamination: A damage function approach
Eloi Schreursa, Irina Cleemputb, Tim Nawrotc, Theo Thewysa
OF ENERGY, WATER AND ENVIRONMENT SYSTEMSeptember 22-27, 2013, Dubrovnik, Croatia
8th CONFERENCE ON SUSTAINABLE DEVELOPMENT UNESCO sponsored conference
a Centre for Environmental Sciences (CMK), Hasselt University, Agoralaan – Building D, 3590 Diepenbeek, BELGIUM; presenting authorb Faculty of Business Economics, Hasselt University, Agoralaan – Building D, 3590 Diepenbeek, BELGIUMc Faculty of Life Sciences, Hasselt University, Agoralaan – Building D, 3590 Diepenbeek, BELGIUM
1. Introduction
• Environmental pollution is a persistent and harmful problem• Exposure to heavy metals can have an impact on public health• Cadmium (Cd) has been associated with osteoporosis, cancer
and kidney damage
2. Methodology
Damage function approach
Health risk assessment• Relative risks• Incidence rates illnesses• Predicted soil Cd values as proxy for level of exposure• Population at each exposure level
PA illnesses = x Populationi x Incidence
Health economic analysis• Hip fracture costs from Hiligsmann et al. (2011)
• COI study of lung cancer• Case-control design (n1 = 359; n2 = 357)• Micro-level database of reimbursed medical costs• Adjusted for comorbidities of smoking
4. Data
Rese
arch
topi
c
5. Results
• Health risk assessment (only lung cancer presented here)
• Health economic analysis
PA cases per year
COI per case (in €)
PA health care cost per year (in €)
Lung cancer 11.62(1.45-17.69)
25,385.60 294,980.67(36,809.12-449,071.26)
Hip fracture men 5.07(0.73-7.91)
10,828 54,897.96(7904.44-85,649.48)
Hip fracture women
15.92(7.69-21.69)
10,389 165,392.88(79,891.41-225,337.41)
Soil Cd
level
RR lung cancer (95% CI)
Population (in 2010)
Incidence (per 100,000)
PA cases per year
1 1.00 102,979 73.3 /2 1.49 (1.04-2.14) 21,891 73.3 5.28 (0.62-8.55)3 1.88 (1.06-3.34) 10,384 73.3 3.57 (0.43-5.33)4 2.22 (1.08-4.58) 3207 73.3 1.29 (0.17-1.84)5 2.52 (1.10-5.85) 1038 73.3 0.46 (0.07-0.63)6 2.80 (1.11-7.15) 802 73.3 0.38 (0.06-0.51)7 3.06 (1.12-8.46) 424 73.3 0.21 (0.03-0.27)8 3.31 (1.12-9.80) 864 73.3 0.44 (0.07-0.57)
11.62 (1.45-17.69)