Quantifying the environmental burden of disease for children and adolescents in Germany

INTRODUCTION: Children and adolescents are more vulnerable to the impacts of environmental risk factors. They are in a sensitive stage of life, where the organ systems are still developing. Already minor interferences can have an effect on their future health. The UKAGEP-project aimed to estimate the Environmental Burden of Disease (EBD) for children and adolescents in Germany. METHODS: We tested the feasibility of applying the EBD-concept, developed by the World Health Organization, for 18 environmental risk factors. Where possible, data from the German Environmental Survey (GerES V) was used as the basis for the analyses. In addition, we performed systematic literature searches to identify adequate exposure-response-relationships. RESULTS: EBD quantifications were performed for 5 out of 18 environmental risk factors (PM2.5, bisphenol A, environmental noise, second-hand smoke and benzene). For the remaining risk factors, only particular steps of the EBD approach were realized. Taking two exemplary risk factors, about 28 % (170,000) of all obesity cases in the 7-17-year-olds were due to the exposure to bisphenol A and nearly 5 % (1,300) of the disability-adjusted life years for lower respiratory tract infections in 3-17-year-olds were attributable to PM2.5 in 2016. CONCLUSIONS: Even though quantifications were performed for several risk factors, we had to conclude that for the remainder, availability and quality, especially of the exposure-response relationships and health data, were not sufficient to estimate burden of disease. Further, the exposure to some of these risk factors assessed in the GerES-V-study was too low to allow estimating the EBD. This does not mean that the identified concentrations were generally uncritical or that lifelong exposure could not lead to health impairments in the further life course. It only means that potential health outcomes have not occurred yet or the concentrations may lead to subclinical alterations in human body systems. KEY MESSAGES: • Environmental risk factors cause considerable burden in children and adolescents. • Estimating the environmental burden of disease for children and adolescents remains challenging.