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Population attributable risks and costs of diabetogenic chemical exposures in the elderly
  1. Leonardo Trasande1,2,3,4,
  2. Erik Lampa5,
  3. Lars Lind6,
  4. P Monica Lind7
  1. 1New York University (NYU) School of Medicine, New York, New York, USA
  2. 2NYU Wagner School of Public Service, New York, New York, USA
  3. 3Department of Nutrition, NYU Steinhardt School of Culture, Education and Human Development, Food & Public Health, New York, New York, USA
  4. 4NYU College of Global Public Health, New York University, New York, New York, USA
  5. 5Uppsala Clinical Research Center, Uppsala, Sweden
  6. 6Department of Medical Sciences, Cardiovascular Epidemiology, Uppsala University, Uppsala, Sweden
  7. 7Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
  1. Correspondence to Dr Leonardo Trasande, Department of Pediatrics, New York University School of Medicine, 403 East 34th Street, New York, NY 10016, USA; leonardo.trasande{at}


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.

  • Epidemiological methods
  • Economic evaluation

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors LT wrote the manuscript, and performed economic analyses. PML and LL provided primary study access and reviewed/edited the manuscript. EL performed statistical analyses. LT and PML are the joint guarantors of this work, including the study design, access to data, and the decision to submit and publish the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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