What Is the Cost of Endocrine Disorders?

 

Endocrine disorders are one of the greatest unappreciated causes of aging and disease in humans and animals. Disruption of key hormones regulating sexual function, energy metabolism, brain function and immune response has widespread systemic effects.  Impairments to these essential systems have been implicated in some of the most common physiological disorders including heart disease, diabetes, cancer, auto-immune disease, obesity and impaired intelligence.  Perhaps even mental disorders and crime can be attributed to them.  The defense of San Francisco mayor George Moscone’s murderer centered on his blood sugar-insulin imbalance.

Are the rising rates of these problems related to man made or natural chemicals in our food or environment, and if so, is it possible to assign a cost to these problems?

A number of endocrine related disorders have been rising over the past several decades. By some estimates, the incidence of diabetes has gone up 49% since 1990 and is now estimated to cost Americans $98 billion dollars a year, according to the American Diabetes Association. Could many of these current cases have been caused or exacerbated by chemicals in the environment and in our foods or is it simply bad culinary choices?

Some economists have stepped forward to place a cost on environmentally related disorders, which if correct, are massive. Muir, et al has estimated that the total costs of just four environmentally related diseases: diabetes, Parkinson’s disease, neurodevelopmental effects and hypothyroidism, and deficits in IQ cost an estimated $568-$792 billion each year in Canada and the US. They estimate 10%-50% of this cost could be environmentally induced, implying that environmental factors could be costing $57-$392 billion dollars for just these four diseases.6 Tom Muir, a senior economist with Environment Canada told E/E Letter than many cost factors were left out of this analysis for simplicity, and that the true costs could be even higher than these estimates.6

Muir said, “These diseases are likely candidates  for environmental causation. They are finding more mechanisms by which these environmental pollutants can lead to things like Parkinson’s, but it is over a long period of time and low level exposure of very many substances. The EPA does not regulate chemicals on anything other than cancer risk and based on animal models and little or nothing else They are starting to look at other things now, but there is not real effort to look at neurodevelopmental effects of the endocrine disruptors. They are mainly looking at estrogenic effects. There are a whole suite of things that can be messed up by these compounds not just acting as estrogens.”

A Mount Sinai Study found that pediatric related diseases related to environmental toxins cost Americans cost an estimated $54.9 billion annually. The study, which was supported by a grant from the now-defunct W. Alton Jones Foundation broke environmental diseases into 4 causes: lead poisoning ($43.4 billion), neurobehavioral disorders ($9.2 billion), asthma ($2 billion), and childhood cancer ($.3 billion).[1]

The authors noted, “This estimate is likely low because it considers only four categories of illness, incorporates conservative assumptions, ignores costs of pain and suffering, and does not include late complications for which etiologic associations are poorly quantified.”

It would be disingenuous to suggest that removing a single chemical from circulation or telling people not to smoke would eliminate this problem. On the other hand, by establishing a surveillance system for tracking these problems, we may discover relatively simple preventive measures that greatly reduce our risk of disease.

Identifying and remediating environmental factors with a role in disease can provide significant benefit. For example, one study conducted by the Center for Disease Control estimates that the campaign to reduce lead in the 1970s could result in a $110 billion to $319 billion economic gain over the lifetime of children born recently with lower levels of lead exposure compared to children born before the 1970s.[2]

One way of looking at this is as overlapping circles identifying the domains of these issues. One circle, the largest, defines the field of all endocrine related disorders. A second specifies the field of research related to chemicals and other environmental factors that cause disease. Some evidence indicates there are some areas of clear overlap between the two areas. But the great unknown is how much overlap actually exists.

One tool used by epidemiologists is the Environmentally Attributed Fraction (EAF), which is a model that assumes that some percentage of a disorder can be attributable to environmental causes. For example, a recent study by Landrigan et al. defined the EAF for lead pollution as 100%, neurobehavioral disorders as 10%, childhood cancer at 5%, and asthma as 30%.[3]

By the same token, a Hormonally Attributed Fraction (HAF) could provide a tool for estimating the relative impact of hormone imbalances on other diseases. For example, estrogen variations have been shown to affect HDL/LDL levels in heart disease, the progression of certain cancers, and autoimmune disorders. A HAF for multiple sclerosis for example, which has been shown to improve with high levels of estrogen, could enable us to calculate the relative cost of estrogen imbalances on this disease. However, some diseases might be affected by multiple hormonal pathways, in which case calculating the HAF would be more complicated.

Many might write off this issue as a normal function of our genes or the cost of living a longer, satisfying life.  However, the rapid and steady growth in the occurrence of chronic diseases such as diabetes, cancer, heart disease, and mental disorders suggests that environmental factors of some kind are clearly involved.

There appears to be a tendency among scientists, government regulators, and lay people to pin the root cause for these disorders on some key factor, such as an industrial chemical. The history of the debate around endocrine disruptors is punctuated about the effects of the chemical de jour: bisphenol-A, phthalates, PCB, dioxin, or phytoestrogens. Unfortunately this kind of myopic approach masks our ability to find more complex underlying patterns that may play a more significant role in creating these disorders.

In addition to the chemical factors that play a role in communications imbalances, other factors could include biological elements (viruses, bacteria, protozoa, and fungi) electromagnetic radiation and fields (i.e. sunlight, cell phones, power lines, CAT scans, and magnetic resonance imaging, and combinations again), rhythms (i.e. when we sleep, exercise, eat, or are exposed to sunlight), and stress.

 

Some interesting data points relating to the costs of endocrine disorders and healthcare in general:

 

Overall Personal and Economic Costs:

Spending for health services and supplies reached $1.3 trillion in 2000, almost three times the 1987 spending level of $477.8 billion.[4]

 

Diabetes

Diabetes is now estimated to cost Americans $98 billion dollars a year, and 17.0 million people have the condition in the US according to the American Diabetes Association.[5] Tom Muir et al has estimated the annual cost of diabetes at $128 billion per year in the US and Canada. [6]

 

Pituitary Disorders

An analysis of the literature by a team of pituitary researchers suggests that 1/5 of all adults have a tumor of the pituitary gland, and that at least 1/3 of these are clinically significant.[7] This could affect a wide variety of other hormonally related endpoints. There is no evidence to suggest this phenomenon is growing.

 

Thyroid

Muir, et al estimates cost of Neurodevelopmental Effects and Hypothyroidism at between $81.5 and $167 billion per year in the US and Canada.6

The American Thyroid Association estimates that over 14 million Americans have thyroid disorders.

 

Osteoporosis

44 million US men and women age 50 and over have Osteoporosis and low bone mass.

The direct medical costs for osteoporosis and the 1.5 million associated fractures is $14 billion ($38 million each day) – and the cost is expected to increase to more than $60 billion by 2020 if nothing is done. By the year 2010, it is estimated that over 52 million women and men in this same age category will be affected and, if current trends continue, the figure will climb to over 61 million by 2020.[8]

A Call to Action, prepared by International Osteoporosis Foundation indicates that osteoporotic fractures in Europe have increased by some 25% since a 1998 European Union report was issued, but government action has been "disappointing" and has not stopped significant suffering resulting from the disease. Dr. Juliet Compston of the University of Cambridge, UK, who was co- editor of the 1998 report -- Osteoporosis in the European Community- Action for Prevention, noted that in the past three years the cost of osteoporosis has increased some 33% and now costs more than Euro 4.8 billion annually in European Community hospital health care alone.[9]

 

 

Obesity

Could natural and man-made chemicals and other factors modulate hormone systems such as ghrelin, contributing to the massive epidemic of obesity in America or is it just a lack of exercise? For example, recent work by Masuno et al. suggests that bisphenol A induced more and bigger fat cells in cell culture studies.[10]

Although this new evidence is suggestive as the whole population is exposed to Bisphenol A and it has been detected in human tissues, there are other obvious risk factors, such as couch potatoeing, and gluttony. The causes are not certain, but it is clear that obesity is on the rise. According to the CDC, in the last 10 years, obesity rates have increased by more than 60% among adults. Approximately 45 million adults, or 25% of the adult population, is obese. Since 1980, obesity rates have doubled among children and tripled among adolescents. Almost 15% of our children and adolescents—about 8 million young people—are overweight.

Among children and adolescents, annual hospital costs related to obesity were $127 million during 1997–1999 (in 2001 constant U.S. dollars), up from $35 million during 1979–1981. In 1995, obesity among U.S. adults cost $99.2 billion, of which $51.6 billion was for direct medical costs. Among U.S. adults in 1996, $31 billion of treatment costs (in year 2000 dollars)—17% of direct medical costs—for cardiovascular disease were related to overweight and obesity.[11]

One University of Michigan Study even found that heavier women tend to be worth less financially. After analyzing the financial data over more than 7,000 men and women, a strong statistical correlation was noted between the female’s weight and their net worth. Obese women tended to have a net worth that was 60% lower than the slimmer ones. No such correlation was noted for the men.[12]

Muir said some evidence suggests that obesity could be involved with other health and endocrine related problems associated with an increased body burden of fat soluble chemicals like PCBs and dioxins.

 

Sexual Dysfunction/Infertility

Number of Women ages 15-44 With Impaired Ability to Have Children: 6.1 million

Number of Women Who've Used Infertility Services: 9 million

Percent of Births That Are "Unwanted": 10% (1995) Number of Infertile Married Couples: 2.1 million

Number of Women Using Infertility Services: 9.3 million

Source: Vital and Health Statistics Series 23, No. 19 based on 1995 data[13]

According to the American Society of Reproductive Medicine, infertility affects 6.1 million American women and their partners, about 10% of the reproductive age population. Infertility is a disease of the reproductive system that affects the male or female with almost equal frequency.[14]

Results from a national survey of people aged 18 to 59 years reported in the February 10, 1999, issue of The Journal of the American Medical Association indicate that sexual dysfunction was common among women (43 percent) and men (31 percent).[15]

 

Cancer

The National Institutes of Health estimate overall costs for cancer in the year 2000 at $180.2 billion: $60 billion for direct medical costs (total of all health expenditures);

$15 billion for indirect morbidity costs (cost of lost productivity due to illness); and, $105.2 billion for indirect mortality costs (cost of lost productivity due to premature death).

 

Type of cancer                         # Cases                           Deaths in 2001

Breast                                      193,700                                   40,600

Genital system                          286,800                                   58,500

Prostate (subset of genital)             198,100                                  31,500

 

Heart Disease

In some cases, hormone replacement therapy has been show to alleviate heart disease If this is the case, could endocrine disorders and endocrine disrupting agents play a role in heart disease? Muir said there is evidence that air pollution  contributes, and that aromatic hydrocarbons, such as PCBs, induce an oxidative stress attack on the endothelium of the blood vessels, including the coronary arteries, causing arteriosclerosis. Heart disease is a major cause of death. According to the US Center for Disease Control, About 57 million Americans live with some form of cardiovascular disease, which causes more than 40% of all deaths in the United States; 950,000 Americans every year. Heart disease and stroke cost the nation almost $260 billion annually.  Heart disease is the leading cause of death for older Americans, and is the leading cause of death for all Americans age 35 and older. Coronary heart disease (CHD), also known as ischemic heart disease, is the most frequent cause of death in the United States -- accounting for 481,458 deaths in 1994.  Death rates from CHD decreased dramatically during the 1960s and 1970s, with slower declines occurring during the 1980s. The recent data for the 1990s indicate that the rate of decline in CHD deaths is continuing to slow down. [16]

 

Mental

The brain’s performance can be adversely affected by changes in the neurotransmitter balance, structural damage, and the buildup of plaques and other waste products. Some of the problems, which may occur from brain imbalances, include impaired intelligence and anti-social behavior (crime) Muir said, “Our paper covers the increase in the prison population and this reflects violence. Also, the neurodevelopmental stuff also has a factor of increased tendency to violence in it.”

According to statistics collated by the Stanley Medical Research Institute, the rate of people committed to psychiatric hospitals grew nearly 8-times between 1860 and 1955 from about .04% of the population to about .34% of the population in the US. In the book,  “The Invisible Plague: The Rise of mental Illness from 1750 to the Present”

 Dr. E Fuller Torrey argues that this rise may be attributable to biological infectious agents, changes in diet, and toxins.

On the other hand, critics such as Dr. Kenneth S. Piver, dismiss these statistics. He noted in the June 26, 2002 Journal of the American Medical Association, that Torrey’s attempt to lump together data from different centuries seems akin to comparing apples and oranges.

 Muir, et al estimates loss of 5 IQ points costs about $30 billion a year in Canada and about 275 to $376 billion in the US annually and the hypothetical dynamic impacts of these cost another $19-$92 billion per year. 6 Data from the US CDC suggests that the per capita costs of mental disorders more than quadrupled between 1975 and 1994 from $31 per person to $128.[17] 

 

Hypospadias

CDC research has indicated significant increase in the occurrence of hypospadias. One study found that rates increased almost twofold in metropolitan Atlanta from 1968 to1993, from around 18 per 10,000 births to approximately 40 per 10,000 births. Similarly, rates increased almost twofold in a national birth defects surveillance system based on hospital discharge data between 1970 and 1993to about 80 per 10,000 male births.[18]

 

 



[1] “Environmental pollutants and disease in American children: estimates of morbidity, mortality, and costs for lead poisoning, asthma, cancer, and developmental disabilities.” Landrigan PJ, Schechter CB, Lipton JM, Fahs MC, Schwartz J. Environ Health Perspect 2002 Jul;110(7):721-8

 

[2] “Economic Gains Resulting from the Reduction in Children's Exposure to Lead in the United States,” Scott D. Grosse, Thomas D. Matte, Joel Schwartz, and Richard J. Jackson, Environmental Health Perspectives Volume 110, Number 6, June 2002

 

[3] “Environmental Pollutants and Disease in American Children: Estimates of Morbidity, Mortality, and Costs for Lead Poisoning, Asthma, Cancer, and Developmental Disabilities,” Philip J. Landrigan, Clyde B. Schechter,  Jeffrey M. Lipton, Marianne C. Fahs, and Joel Schwartz, Environmental Health Perspectives Volume 110, Number 7, July 2002

 

[4] Cathy A. Cowan, Patricia A. McDonnell, Katharine R. Levit, and Mark A. Zezza

Burden of Health Care Costs: Businesses, Households, and Governments, 1987-2000 http://cms.hhs.gov/review/02spring/cowan.pdf

 

[5] http://www.diabetes.org/main/info/facts/impact/default2.jsp

 

[6] “Societal Costs of Exposure to Toxic Substances: Economic and Health Costs of Four Case Studies That Are Candidates for Environmental Causation,” Tom Muir and Mike Zegarac. Environmental Health Perspectives Volume 109, Supplement 6, December 2001

 

[7] 10th Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists presentation by Keith Friend, Dr. Keith Friend, formerly University of Texas at MD Anderson Cancer Center (Now at Pharmacia, Upjohn),

Dr. Shereen Ezzat, MD, Professor of Medicine at University of Toronto,

Dr. William Couldwell, Professor of Neurosurgery at University of Utah,

Dr. Ian McCutcheon, MD Anderson Cancer Center in Houston Texas.

 

[8] http://www.nof.org/advocacy/prevalence/index.htm

 

[9] http://www.osteofound.org/press_centre/pr_2001_12_04b.html

 

[10] Masuno, H, T Kidani, K Sekiya, K Sakayama, T Shiosaka, H Yamamoto and K Honda. 2002. Bisphenol A in combination with insulin can accelerate the conversion of 3T3-L1 fibroblasts to adipocytes.  Journal of Lipid Research 3:676-684.

 

[11] http://www.cdc.gov/nccdphp/pe_factsheets/pe_pa.htm

 

 

[12] http://finance.monster.com/articles/obesity/

Raw U Mich Data supporting this story:

http://www.umich.edu/~newsinfo/Releases/2000/Nov00/obesity.html

 

[13] http://www.cdc.gov/nchs/fastats/fertile.htm

 

[14] http://www.asrm.org/Patients/FactSheets/invitro.html

 

[15] http://www.medem.com/MedLB/article_detaillb.cfm?article_ID=ZZZSAC20NAC&sub_cat=2

 

[16] http://www.cdc.gov/od/oc/media/fact/cardiova.htm

 

[17] http://www.cdc.gov/nchs/products/pubs/pubd/hus/tables/2001/01hus125.pdf

 

[18] Paulozzi LJ, Erickson JD, Jackson RJ. Hypospadias trends in two US surveillance systems. Pediatrics. 1997 Nov;100(5):831-4.