PMID- 35667403
OWN - NLM
STAT- MEDLINE
DCOM- 20220810
LR  - 20220824
IS  - 1096-0953 (Electronic)
IS  - 0013-9351 (Linking)
VI  - 213
DP  - 2022 Oct
TI  - Public healthcare costs associated with long-term exposure to mixtures of 
      persistent organic pollutants in two areas of Southern Spain: A longitudinal 
      analysis.
PG  - 113609
LID - S0013-9351(22)00936-7 [pii]
LID - 10.1016/j.envres.2022.113609 [doi]
AB  - BACKGROUND: Polychlorinated biphenyls and organochlorine pesticides are 
      persistent organic pollutants (POPs) that had been banned or restricted in many 
      countries, including Spain. However, their ubiquity still poses environmental and 
      human health threats. OBJECTIVE: To longitudinally explore public healthcare 
      costs associated with long-term exposure to a mixture of 8 POPs in a cohort of 
      residents of two areas of Granada Province, Southern Spain. METHODS: Longitudinal 
      study in a subsample (n = 385) of GraMo adult cohort. Exposure assessment was 
      performed by analyzing adipose tissue POP concentrations at recruitment. Average 
      primary care (APC) and average hospital care (AHC) expenditures of each 
      participant over 14 years were estimated using the data from their medical 
      records. Data analyses were performed by robust MM regression, weighted quantile 
      sum regression (WQS) and G-computation analysis. RESULTS: In the adjusted robust 
      MM models for APC, most POPs showed positive beta coefficients, being 
      Hexachlorobenzene (HCB) significantly associated (beta: 1.87; 95% Confidence 
      interval (95%CI): 0.17, 3.57). The magnitude of this association increased (beta: 
      3.72; 95%CI: 0.80, 6.64) when the analyses were restricted to semi-rural 
      residents, where beta-HCH was also marginally-significantly associated to APC (beta: 
      3.40; 95%CI: -0.10, 6.90). WQS revealed a positive but non-significant mixture 
      association with APC (beta: 0.14; 95%CI: -0.06, 0.34), mainly accounted for by beta-HCH 
      (54%) and HCB (43%), that was borderline-significant in the semi-rural residents 
      (beta: 0.23; 95%CI: -0.01, 0.48). No significant results were observed in 
      G-Computation analyses. CONCLUSION: Long-term exposure to POP mixtures might 
      represent a modifiable factor increasing healthcare costs, thus affecting the 
      efficiency of the healthcare systems. However, and owing the complexity of the 
      potential causal pathways and the limitations of the present study, further 
      research is warranted to fully elucidate ascertain whether interventions to 
      reduce human exposure should be considered in healthcare policies.
CI  - Copyright (c) 2022 The Authors. Published by Elsevier Inc. All rights reserved.
FAU - Perez-Carrascosa, Francisco Miguel
AU  - Perez-Carrascosa FM
AD  - Universidad de Granada, Departamento de Medicina Preventiva y Salud Publica, 
      Granada, Spain; Instituto de Investigacion Biosanitaria IBS.GRANADA, Spain; 
      Servicio de Oncologia Radioterapica, Hospital Universitario Virgen de Las Nieves, 
      Granada, Spain.
FAU - Barrios-Rodriguez, Rocio
AU  - Barrios-Rodriguez R
AD  - Universidad de Granada, Departamento de Medicina Preventiva y Salud Publica, 
      Granada, Spain; Instituto de Investigacion Biosanitaria IBS.GRANADA, Spain; CIBER 
      de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
FAU - Gomez-Pena, Celia
AU  - Gomez-Pena C
AD  - Instituto de Investigacion Biosanitaria IBS.GRANADA, Spain; Servicio de Farmacia 
      Hospitalaria, Hospital Universitario San Cecilio, Granada, Spain.
FAU - Salcedo-Bellido, Inmaculada
AU  - Salcedo-Bellido I
AD  - Universidad de Granada, Departamento de Medicina Preventiva y Salud Publica, 
      Granada, Spain; Instituto de Investigacion Biosanitaria IBS.GRANADA, Spain; CIBER 
      de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
FAU - Velasco-Garcia, Maria Eugenia
AU  - Velasco-Garcia ME
AD  - Instituto de Investigacion Biosanitaria IBS.GRANADA, Spain.
FAU - Jimenez-Moleon, Jose Juan
AU  - Jimenez-Moleon JJ
AD  - Universidad de Granada, Departamento de Medicina Preventiva y Salud Publica, 
      Granada, Spain; Instituto de Investigacion Biosanitaria IBS.GRANADA, Spain; CIBER 
      de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
FAU - Garcia-Ruiz, Antonio
AU  - Garcia-Ruiz A
AD  - Departamento de Farmacologia y Pediatria, Universidad de Malaga, Malaga, Spain; 
      Instituto de Investigacion Biomedica de Malaga (IBIMA), Malaga, Spain.
FAU - Navarro-Espigares, Jose Luis
AU  - Navarro-Espigares JL
AD  - Universidad de Granada, Departamento de Economia Internacional y de Espana, 
      Granada, Spain; Direccion Economica y Servicios Generales, Hospital Universitario 
      Virgen de Las Nieves, Granada, Spain.
FAU - Requena, Pilar
AU  - Requena P
AD  - Universidad de Granada, Departamento de Medicina Preventiva y Salud Publica, 
      Granada, Spain; Instituto de Investigacion Biosanitaria IBS.GRANADA, Spain; CIBER 
      de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain.
FAU - Munoz-Sanchez, Carmen
AU  - Munoz-Sanchez C
AD  - Unidad de Tecnologias de La Informacion y Comunicaciones, Hospital Universitario 
      San Cecilio, Granada, Spain.
FAU - Arrebola, Juan Pedro
AU  - Arrebola JP
AD  - Universidad de Granada, Departamento de Medicina Preventiva y Salud Publica, 
      Granada, Spain; Instituto de Investigacion Biosanitaria IBS.GRANADA, Spain; CIBER 
      de Epidemiologia y Salud Publica (CIBERESP), Madrid, Spain. Electronic address: 
      jparrebola@ugr.es.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220603
PL  - Netherlands
TA  - Environ Res
JT  - Environmental research
JID - 0147621
RN  - 0 (Environmental Pollutants)
RN  - 0 (Hydrocarbons, Chlorinated)
RN  - 0 (Pesticides)
RN  - 4Z87H0LKUY (Hexachlorobenzene)
RN  - DFC2HB4I0K (Polychlorinated Biphenyls)
SB  - IM
MH  - Adult
MH  - *Environmental Pollutants/analysis
MH  - Health Care Costs
MH  - Hexachlorobenzene/analysis
MH  - Humans
MH  - *Hydrocarbons, Chlorinated/analysis
MH  - Longitudinal Studies
MH  - Persistent Organic Pollutants
MH  - *Pesticides/analysis
MH  - *Polychlorinated Biphenyls/analysis
MH  - Spain
OTO - NOTNLM
OT  - Biomonitoring
OT  - Healthcare expenditure
OT  - Organochlorine pesticides
OT  - Persistent organic pollutants
OT  - Polychlorinated biphenyls
EDAT- 2022/06/07 06:00
MHDA- 2022/08/11 06:00
CRDT- 2022/06/06 19:23
PHST- 2022/03/04 00:00 [received]
PHST- 2022/05/24 00:00 [revised]
PHST- 2022/06/01 00:00 [accepted]
PHST- 2022/06/07 06:00 [pubmed]
PHST- 2022/08/11 06:00 [medline]
PHST- 2022/06/06 19:23 [entrez]
AID - S0013-9351(22)00936-7 [pii]
AID - 10.1016/j.envres.2022.113609 [doi]
PST - ppublish
SO  - Environ Res. 2022 Oct;213:113609. doi: 10.1016/j.envres.2022.113609. Epub 2022 
      Jun 3.