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Table 3 Overview of available disease burden estimates attributable to chemicals

From: Knowns and unknowns on burden of disease due to chemicals: a systematic review

Chemicals/Groups of chemicals Disease outcomes considered (attributable fraction) Deaths DALYs Main limitations¤ Data year/method§
Chemicals in acute poisonings   526,000 (sub-total) 9,666,000 (sub-total)   
Chemicals (including drugs) involved in unintentional acute poisonings (methanol, diethylene glycol, kerosene, pesticides etc.) Unintentional poisonings (71%) 240,000a 5,246,000a Limited to preventable poisonings. Total unintentional poisonings would amount to 346,000 deaths and 7,445,000 DALYs[12] 2004; C [13]b
Chemicals involved in unintentional occupational poisonings Unintentional poisonings (occupational) (8.6%) 30,000c 643,000c - 2004; A [14]
Pesticides pesticides involved in self-inflicted injuries Self-inflicted injuries (23%) 186,000 4,420,000 Limited to preventable self inflicted injuries. Impact of accidental and chronic exposures not considered. 2002; C [13]
Chemicals in occupational exposures (longer term effects) 581,000 (sub-total) 6,763,000 (sub-total)   
Asbestos Malignant mesothelioma (NA); trachea, bronchus, lung cancer (0.3%); asbestosis (NA) 107,000d 1,523,000d - 2004; A [14], [50]
Occupational lung carcinogens (arsenic, asbestos, beryllium, cadmium, chromium, diesel exhaust, nickel, silica) Trachea, bronchus, lung cancer (8.6%) 111,000 1,011,000 Only 8 of the chemicals or chemical mixtures classified as carcinogenic or probably carcinogenic to humans taken into account 2004; A [14]
Occupational leukaemogens (benzene, ethylene oxide, ionizing radiation) Leukaemia (2.3%) 7,400e 113,000e Only 2 of the chemicals or chemical mixtures classified as carcinogenic or probably carcinogenic to humans taken into account 2004; A [14]
Occupational particulates - causing COPD (dusts, fumes/gas) COPD (13%) 375,000f 3,804,000f - 2004; A [14]
Occupational particulates - other respiratory diseases than COPD (silica, asbestos and coal mine dust) Asbestosis (NA); silicosis (NA); pneumoconiosis (NA) 29,000 1,062,000 - 2004; A [14]
Air pollutant mixtures   3,720,000 (sub-total) 60,669,000 (sub-total)   
Outdoor air pollutants (particulate matter, sulfur dioxide, nitrogen oxides, benzo[a]pyrene, benzene, others) Lung cancer (7.9%); acute respiratory infections (1.6%); selected cardiopulmonary diseases (3.4%) 1,152,000 8,747,000 Only urban air pollution in cities with >100 000 inhabitants taken into account. Health impact from rural air pollution unknown. 2004; A [14]
Outdoor air pollutants emitted from ships (particulate matter, sulfur dioxide, nitrogen oxides, benzo[a]pyrene, benzene, others) Lung cancer (0.3%); selected cardiopulmonary diseases (0.4%) 60,000g NA - 2002; B [95]
Indoor air pollutants from solid fuel combustion (carbon monoxide, nitrogen oxides, sulfur oxides, benzene, formaldehyde, polyaromatic compounds, particulates, others) Lung cancer (2.9%); acute respiratory infections (33%); COPD (33%) 1,965,000 41,009,000 Disease burden from emissions from building materials and household products is not know. BoD from second hand smoke has been evaluated separately. 2004; A [14]
Second-hand smoke (nicotine, formaldehyde, carbon monoxide, phenols, nitrogen oxides, naphthalenes, tar, nitrosamine, PAHs, vinyl chloride, various metals, hydrogen cyanide, ammonia, others) Lower respiratory infections (6.3%); otitis (1.7%); asthma (11%); lung cancer (1.8%); ischaemic heart disease (4.5%) 603,000 10,913,000 - 2004; B [29]
Single chemicals with mostly longer term effects   152,000 (sub-total) 9,102,000 (sub-total)   
Lead Mild mental retardation; Cardiovascular diseases 143,000 8,977,000 - 2004; A [14]
Arsenic in drinking-water Diabetes mellitus (0.04%) ischemic heart disease (0,11%); lung cancer (0.25%); bladder cancer (1.2%); kidney cancer (NA); skin cancer (0.30%) 9,100a 125,000a Limited to exposure through drinking water. Limited to Bangladesh. 2001; B [11]
Total #,h Total in children <15 years All considered diseases 4,879,000 (8.3%) 1,073,000 (22%) 86,200,000 (5.7%) 46,627,000 (54%)   Mainly 2004; A
  1. DALYs are "Disability-adjusted life years", a weighted measure of years of life lost due to premature death, and years lived with disability. ¤ Only outcomes qualified as strong evidence were considered. § Methods: A: Comparative Risk Assessment (CRA); B: Based on exposure and exposure-response (similar to CRA); C: Evidence synthesis and expert evaluation. # The estimates were developed within three years and their pooling is unlikely to introduce a significant error. NA: not available. -: none.
  2. a Estimate not compared to counterfactual exposure, which is however estimated to be negligible using a theoretical minimum exposure given available management options for concerned chemicals.
  3. b Values updated for 2004 based on original reference.
  4. c Already included in total unintentional acute poisonings and therefore not included again in the total.
  5. d Lung cancer and asbestosis caused by asbestos are also considered in occupational lung carcinogens and particulates and this part of the burden is therefore not counted twice in the total.
  6. e Also includes a small fraction of leukaemia caused by ionizing radiation.
  7. f Parts of the particulates are organic in nature, and the estimate therefore includes a small fraction that is not or not directly related to chemicals
  8. g Overlaps with the burden from outdoor air pollution and is therefore not included in the total.
  9. h Total is corrected for double counting (chemicals considered in more than one estimate); not all disease burdens are however additive, and joint exposures could lead to slight overestimate (see Methods section).