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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 (NO) 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 NO 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.
This article was published in the following journal.
Name: Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany))
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Component of the NATIONAL INSTITUTES OF HEALTH. It conducts and supports basic and applied research to reduce the burden of human illness and dysfunction from environmental causes by, defining how environmental exposures, genetic susceptibility, and age interact to affect an individual's health. It was established in 1969.
Deaths that occur before LIFE EXPECTANCY is reached within a given population.
Number of deaths of children between one year of age to 12 years of age in a given population.
Postnatal deaths from BIRTH to 365 days after birth in a given population. Postneonatal mortality represents deaths between 28 days and 365 days after birth (as defined by National Center for Health Statistics). Neonatal mortality represents deaths from birth to 27 days after birth.
A type of cardiac arrhythmia with premature contractions of the HEART VENTRICLES. It is characterized by the premature QRS complex on ECG that is of abnormal shape and great duration (generally >129 msec). It is the most common form of all cardiac arrhythmias. Premature ventricular complexes have no clinical significance except in concurrence with heart diseases.
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