Universität zu Köln

Morfeld, Peter and Erren, Thomas C. (2019). Why is the Number of Premature Deaths Due to Environmental Exposures not Appropriately Quantifiable? Gesundheitswesen, 81 (2). S. 144 - 150. STUTTGART: GEORG THIEME VERLAG KG. ISSN 1439-4421

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Abstract

Epidemiological studies and their applications in regulations of hazardous substances (e.g. by WHO, USA, EU) often quantify effects of environmental exposures on populations (burden of disease) by calculating numbers of premature deaths due to exposure. A recent example is the study by Schneider et al., commissioned by the German Federal Environmental Agency (Umweltbundesamt), into the burden of disease caused by exposures to nitrogen dioxide (NO2) in Germany. The authors assessed the proportion of premature deaths due to exposure by the Attributable Fraction (AF). However, true numbers of premature deaths caused by NO2 could be much higher or smaller. Indeed, Robins and Greenland showed in 1989 that the AF approach is inappropriate. Despite its far-reaching relevance for epidemiology and public health, their seminal work was not adequately taken into consideration, possibly due to its sophisticated level of mathematical argumentation. Our contribution illustrates - with simple examples - unappreciated but important pitfalls. We recommend that the concept of number of premature deaths be abandoned and years of life lost due to exposure be provided instead, calculated per capita. However, years of life lost due to exposure should not be stratified by age or causes of death (diseases). Furthermore, we show that Disability Adjusted Life Years (DALY) do not provide a meaningful measure to evaluate the effect of environmental exposures on populations.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Morfeld, Peter UNSPECIFIED UNSPECIFIED UNSPECIFIED Erren, Thomas C. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-157445
DOI:	10.1055/a-0832-2038
Journal or Publication Title:	Gesundheitswesen
Volume:	81
Number:	2
Page Range:	S. 144 - 150
Date:	2019
Publisher:	GEORG THIEME VERLAG KG
Place of Publication:	STUTTGART
ISSN:	1439-4421
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language AMBIENT AIR-POLLUTANTS; HEALTH IMPACTS; ESTIMABILITY; PROBABILITY; CAUSATION; MORTALITY Multiple languages Public, Environmental & Occupational Health Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15744