Population attributable risks and costs of diabetogenic chemical exposures in the elderly

J Epidemiol Community Health. 2017 Feb;71(2):111-114. doi: 10.1136/jech-2016-208006. Epub 2016 Oct 27.


Background: A previous analysis examined the contribution of endocrine disruptor exposures (endocrine-disrupting chemicals, EDCs) to adult diabetes, but was limited to effects of phthalates in middle-aged women and did not simultaneously examine multiple EDCs which are known to coexist in the environment. We therefore endeavoured to quantify potential reductions in diabetes and disease costs that could result from reducing synthetic chemical diabetogenic exposures in the elderly in Europe.

Methods: We leveraged the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study (∼1000 participants), which has measured exposure to phthalates; dichlorodiphenyltrichloroethylene; polychlorinated biphenyls (PCBs) and perfluoroalkyl substances to examine their independent contribution to diabetes. We estimated risk reductions assuming identical 25% reductions across levels of 4 selected compounds (PCB 153, monoethylphthalate, dichlorodiphenyldichloroethylene and perfluorononanoic acid), and diabetes costs saved in European men and women if diabetogenic exposures are limited.

Results: Reduction of chemical exposures was associated with a 13% (95% CI 2% to 22%) reduction in prevalent diabetes, compared with 40% resulting from an identical (25%) reduction in body mass index (BMI) in cross-sectional analyses. Extrapolating to Europe, 152 481 cases of diabetes in Europe and €4.51 billion/year in associated costs could be prevented, compared with 469 172 cases prevented by reducing BMI.

Conclusions: These findings support regulatory and individual efforts to reduce chemical exposures to reduce the burden and costs of diabetes.

Keywords: DIABETES; ENVIRONMENTAL HEALTH; Economic evaluation; Epidemiological methods.

MeSH terms

  • Aged
  • Biomarkers / metabolism
  • Body Mass Index
  • Cost of Illness
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / chemically induced*
  • Diabetes Mellitus, Type 2 / economics*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / prevention & control*
  • Endocrine Disruptors / toxicity*
  • Environmental Exposure / adverse effects*
  • Environmental Exposure / prevention & control*
  • Environmental Pollutants / toxicity*
  • Europe / epidemiology
  • Female
  • Humans
  • Male
  • Prevalence
  • Sweden / epidemiology


  • Biomarkers
  • Endocrine Disruptors
  • Environmental Pollutants