Chained Risk Assessment for Life-Long Disease Burden of Early Exposures–Demonstration of Concept Using Prenatal Maternal Smoking

Isabell K. Rumrich, Kirsi Vähäkangas, Matti Viluksela and Otto Hänninen
Additional contact information
Isabell K. Rumrich: Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 95, 70701 Kuopio, Finland
Kirsi Vähäkangas: Faculty of Health Sciences, School of Pharmacy/Toxicology, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland
Matti Viluksela: Faculty of Health Sciences, School of Pharmacy/Toxicology, University of Eastern Finland (UEF), P.O. Box 1627, 70211 Kuopio, Finland
Otto Hänninen: Department of Public Health Solutions, Finnish Institute for Health and Welfare (THL), P.O. Box 95, 70701 Kuopio, Finland

IJERPH, 2020, vol. 17, issue 5, 1-17

Abstract: Traditional risk factors and environmental exposures only explain less than half of the disease burden. The developmental origin of the health and disease (DOHaD) concept proposes that prenatal and early postnatal exposures increase disease susceptibility throughout life. The aim of this work is to demonstrate the application of the DOHaD concept in a chained risk assessment and to provide an estimate of later in life burden of disease related to maternal smoking. We conducted three systematic literature searches for meta-analysis and reviewed the literature reporting meta-analyses of long-term health outcomes associated with maternal smoking and intermediate risk factors (preterm birth, low birth weight, childhood overweight). In the chained model the three selected risk factors explained an additional 2% (34,000 DALY) of the total non-communicable disease burden (1.4 million DALY) in 2017. Being overweight in childhood was the most important risk factor (28,000 DALY). Maternal smoking was directly associated with 170 DALY and indirectly via the three intermediate risk factors 1000 DALY (1200 DALY in total). The results confirm the potential to explain a previously unattributed part of the non-communicable diseases by the DOHAD concept. It is likely that relevant outcomes are missing, resulting in an underestimation of disease burden.

Keywords: Burden of disease; chained risk assessment; developmental origin of health and disease (DOHaD); smoking; pregnancy; low birth weight; preterm birth; overweight, systematic literature review (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (2)

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Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:17:y:2020:i:5:p:1472-:d:324842

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