Studies have documented disparities in exposure to endocrine-disrupting chemicals (EDC), but no studies have investigated potential implications for racial/ethnic disparities in chronic disease and associated costs. Our objective was to examine EDC levels in the US population according to race/ethnicity and to quantify disease burden and associated costs.
Study Design and Setting
EDC exposure levels in 2007–2010 were obtained from the National Health and Nutrition Examination Surveys. The associated disease burden and costs for 12 exposure–response relationships were determined for non-Hispanic Whites, non-Hispanic Blacks, Mexican Americans, Other Hispanics, and Other/Multicultural.
EDC exposure levels and associated burden of disease and costs were higher in non-Hispanic Blacks ($56.8 billion; 16.5% of total costs) and Mexican Americans ($50.1 billion; 14.6%) compared with their proportion of the total population (12.6% and 13.5%, respectively). Associated costs among non-Hispanic whites comprised 52.3% of total costs ($179.8 billion) although they comprise 66.1% of the US population. These disparities are driven by generally higher exposure to persistent pesticides and flame retardants among non-Hispanic blacks and Mexican Americans.
Our estimates suggest that racial/ethnic disparities in chronic diseases in the US may be because of chemical exposures and are an important tool to inform policies that address such disparities.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Clinical Epidemiology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Endocrine-disrupting chemicals: an Endocrine Society scientific statement.Endocr Rev. 2009; 30: 293-342
- WHO (World Health Organization)/UNEP (United Nations Environment Programme) 2013. The state-of-the-science of endocrine disrupting chemicals – 2012.UNEP/WHO, Geneva2013 (Available at)http://www.who.int/ceh/publications/endocrine/en/Date accessed: December 14, 2015
- EDC-2: The Endocrine Society's second scientific statement on endocrine-disrupting chemicals.Endocr Rev. 2015; 36: E1-E150
- Exposure to endocrine-disrupting chemicals in the USA: a population-based disease burden and cost analysis.Lancet Diabetes Endocrinol. 2016; 4: 996-1003
- Burden of disease and costs of exposure to endocrine disrupting chemicals in the European Union: an updated analysis.Andrology. 2016; 4: 565-572
- U.S. disparities in health: descriptions, causes, and mechanisms.Annu Rev Public Health. 2008; 29: 235-252
- Race, socioeconomic status, and health: complexities, ongoing challenges, and research opportunities.Ann N Y Acad Sci. 2010; 1186: 69-101
- Conclusion and future directions: CDC health disparities and inequalities report - United States, 2013.MMWR Suppl. 2013; 62: 184-186
- Race, ethnicity, and socioeconomic status in research on child health.Pediatrics. 2015; 135: e225-e237
- Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care.JAMA. 2000; 283: 2579-2584
- Understanding the cumulative impacts of inequalities in environmental health: implications for policy.Health Aff (Millwood). 2011; 30: 879-887
- Disparities in environmental exposures to endocrine-disrupting chemicals and diabetes risk in vulnerable populations.Diabetes Care. 2018; 41: 193-205
- Racial/ethnic disparities in environmental endocrine disrupting chemicals and women's reproductive health outcomes: epidemiological examples across the life course.Curr Epidemiol Rep. 2016; 3: 161-180
- A novel look at racial health disparities: the interaction between social disadvantage and environmental health.Am J Public Health. 2012; 102: 2344-2351
- Healthy people 2020.(Available at)https://www.healthypeople.gov/2020/About-Healthy-PeopleDate accessed: June 23, 2017
- Social disparities in exposures to bisphenol A and polyfluoroalkyl chemicals: a cross-sectional study within NHANES 2003-2006.Environ Health. 2012; 11: 10
- Bisphenol-A and disparities in birth outcomes: a review and directions for future research.J Perinatol. 2010; 30: 2-9
- A review of hair product use on breast cancer risk in African American women.Cancer Med. 2016; 5: 597-604
- Race/ethnicity-specific associations of urinary phthalates with childhood body mass in a nationally representative sample.Environ Health Perspect. 2013; 121: 501-506
- Costs of environment-related health effects: a plan for continuing study.National Academy Press, Washington, DC1981
- How much global ill health is attributable to environmental factors?.Epidemiology. 1999; 10: 573-584
- Bureau of labor statistics, consumer price index. 2010 (Available at)http://www.bls.gov/cpi/Date accessed: January 21, 2016
- Urban green space and the pursuit of health equity in parts of the United States.Int J Environ Res Public Health. 2017; 14: 1432
- Estimating burden and disease costs of exposure to endocrine-disrupting chemicals in the European Union.J Clin Endocrinol Metab. 2015; 100: 1245-1255
- Female reproductive disorders, diseases and costs of exposure to endocrine disrupting chemicals in the European Union.J Clin Endocrinol Metab. 2016; 101: 1562-1570
- Cost-of-illness methodology: a guide to current practices and procedures.Milbank Mem Fund Q Health Soc. 1982; 60: 429-462
- Recommendations of the panel on cost-effectiveness in health and medicine.JAMA. 1996; 276: 1253-1258
- Demographic turning points for the United States: population projections for 2020 to 2060.2018 (Available at https://www.census.gov/content/dam/Census/library/publications/2018/demo/P25_1144.pdf, Accessed 16 May 2018)
- Race/ethnicity and asthma among children presenting to the emergency department: differences in disease severity and management.Pediatrics. 2003; 111: e615-e621
- Births: final data for 2016.2018: 67 (Number 1): CDC. Available at: https://www.cdc.gov/nchs/nvss/births.htm. Accessed 16 May 2018
- Children's environmental chemical exposures in the USA, NHANES 2003-2012.Environ Sci Pollut Res Int. 2018; 25: 5336-5343
- Systematic assessment of the correlations of household income with infectious, biochemical, physiological, and environmental factors in the United States, 1999-2006.Am J Epidemiol. 2015; 181: 171-179
- A historical overview of health disparities and the potential of eHealth solutions.J Med Internet Res. 2005; 7: e50
- Smedley B.D. Stith A.Y. Nelson A.R. Unequal treatment: confronting racial and ethnic disparities in healthcare. Institute of medicine (US) committee on understanding and eliminating racial and ethnic disparities in health care. National Academies Press (US), Washington (DC)2003
- Neighborhood disparities in access to healthy foods and their effects on environmental justice.Am J Public Health. 2012; 102: 1644-1654
- Cancer risk disparities between Hispanic and non-Hispanic white populations: the role of exposure to indoor air pollution.Environ Health Perspect. 2009; 117: 1925-1931
- Women's exposure to phthalates in relation to use of personal care products.J Expo Sci Environ Epidemiol. 2013; 23: 197-206
- The environmental injustice of beauty: framing chemical exposures from beauty products as a health disparities concern.Am J Obstet Gynecol. 2017; 217: 418.e1-418.e6
- Reducing phthalate, paraben, and phenol exposure from personal care products in adolescent girls: findings from the HERMOSA intervention study.Environ Health Perspect. 2016; 124: 1600-1607
- Linking 'toxic outliers' to environmental justice communities.Environ Res Lett. 2016; 1
- Socio-demographic differences in toxic release inventory siting and emissions in Metro Atlanta.Int J Environ Res Public Health. 2016; 13
- Bill tracker: adopted policy. Toxic flame retardants.2017 (Available at)http://www.saferstates.com/bill-tracker/Date accessed: December 26, 2017
- A framework to guide selection of chemical alternatives.National Academies Press (US), Washington (DC)2014 (Available at)https://www.nap.edu/catalog/18872/a-framework-to-guide-selection-of-chemical-alternativesDate accessed: December 27, 2017
- Draft alternatives analysis guide.(Available at)http://www.dtsc.ca.gov/SCP/AlternativesAnalysisGuidance.cfmDate: 2016Date accessed: December 27, 2017
- Updating the toxic substances control act to protect human health.JAMA. 2016; 315: 1565-1566
- The personal care products safety Act.JAMA Intern Med. 2018; 178: 601-602
Published online: December 07, 2018
Accepted: November 30, 2018
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conflict of interest statement: The authors have no conflicts of interest relevant to this article to disclose.
© 2018 Elsevier Inc. All rights reserved.