Abstract
Regulatory agencies are under increased pressure to consider broader public health concerns that extend to multiple pollutant exposures, multiple exposure pathways, and vulnerable populations. Specifically, cumulative risk assessment initiatives have stressed the importance of considering both chemical and non-chemical stressors, such as socioeconomic status (SES) and related psychosocial stress, in evaluating health risks. The integration of non-chemical stressors into a cumulative risk assessment framework has been largely driven by evidence of health disparities across different segments of society that may also bear a disproportionate risk from chemical exposures. This review will discuss current efforts to advance the field of cumulative risk assessment, highlighting some of the major challenges, discussed within the construct of the traditional risk assessment paradigm. Additionally, we present a summary of studies of potential interactions between social stressors and air pollutants on health as an example of current research that supports the incorporation of non-chemical stressors into risk assessment. The results from these studies, while suggestive of possible interactions, are mixed and hindered by inconsistent application of social stress indicators. Overall, while there have been significant advances, further developments across all of the risk assessment stages (i.e., hazard identification, exposure assessment, dose-response, and risk characterization) are necessary to provide a scientific basis for regulatory actions and effective community interventions, particularly when considering non-chemical stressors. A better understanding of the biological underpinnings of social stress on disease and implications for chemical-based dose-response relationships is needed. Furthermore, when considering non-chemical stressors, an appropriate metric, or series of metrics, for risk characterization is also needed. Cumulative risk assessment research will benefit from coordination of information from several different scientific disciplines, including, for example, toxicology, epidemiology, nutrition, neurotoxicology, and the social sciences.
Highlights
Cumulative risk assessment has existed in some form for many years, such as in the consideration of multiple chemical exposures, sensitive sub-populations, and multi-pathway evaluations in Superfund risk assessments [1]
While United States Environmental Protection Agency (US EPA) and National Research Council (NRC) frameworks clearly state that both non-chemical and chemical stressors can be considered in a cumulative risk assessment, this paper will focus on identification, quantification, and characterization of social stressors
Larger mortality risk estimates were observed in least-educated for all cause, respiratory, and heart disease-related mortality The PM10-mortality association was greater in lower income and lower socioeconomic status (SES) communities
Summary
Cumulative risk assessment has existed in some form for many years, such as in the consideration of multiple chemical exposures, sensitive sub-populations, and multi-pathway evaluations in Superfund risk assessments [1]. Despite the inclusion of non-chemical stressors in the definition of cumulative risk, cumulative risk assessments to date have not included these stressors in a quantitative manner [6,7] As part of our review, and to highlight the type of information that will be necessary to advance the incorporation of non-chemical stressors into risk assessment, we summarize available epidemiological research that explores the interactions between non-chemical stressors and air pollutants Results from these studies are mixed, this research provides important insights related to a better understanding of the cumulative impacts of these stressors. We discuss the findings from these studies as well as their limitations
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More From: International Journal of Environmental Research and Public Health
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