Monte Carlo Simulation of Fluoride Over-Exposure in the Frameworks of Disability-Adjusted Life Years (DALYs) and Health Risk Assessment Coupled with a Variance Decomposition Approach in Drinking Water of South-Western Iran
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Title:
Monte Carlo Simulation of Fluoride Over-Exposure in the Frameworks of Disability-Adjusted Life Years (DALYs) and Health Risk Assessment Coupled with a Variance Decomposition Approach in Drinking Water of South-Western Iran
Description:
There are restricted studies of non-single-value health exposure models regarding fluoride intake in Iran. As such, we adopted a probability-based approach for higher accuracy along with sensitivity analysis to reduce the ambiguity of the health risk model of Fars and Bushehr Provinces. Fluoride contents of 57 sites with total water samples of 8,053 (N=8,053) were analyzed. The hazard quotient of the 95th percentile (HQ>1) revealed that all infants and children of the whole study area are in danger of over-receiving fluoride. To measure the contributions of predictor variables in the model outcome, a global method was employed. Sobol’ sensitivity analysis indices, including first-order, second-order, and total order, disclosed that fluoride concentration (Cw) and ingestion rate (IRw), as well as their mutual interactions, are the most influential factors in the oral health risk model. The fluoride contents beyond desirable limits develops endemic diseases. Hence, the fluoride-induced disease burden, including dental fluorosis and overall skeletal fractures, was explored via disability-adjusted life years (DALYs). DALYs rate of dental fluorosis was as high as 981.45 (uncertainty interval: UI 95% 353.23 to 1618.40) in Lamerd, and maximum DALYs of skeletal fractures occurred in Mohr 71.61(49.75–92.71), in Fars Province, indicating severe dental fluorosis but mild hazard regarding fractures. Residents of the Tang-e Eram in Bushehr Province with a DALYs rate of 3609.40 (1296.68–5993.73) for dental fluorosis and DALYs rate of 284.67 (199.11–367.99) related to the skeletal fractures was the most threatened area. Moreover, by implanting a novel Monte Carlo approach, the possible model outputs of DALYs were evaluated, considering average-case and worst-case scenarios as central tendency exposure and reasonable maximum exposure, respectively. DALYs were compared in both scenarios, highlighting the role of food source intake in receiving fluoride. This research insists on implanting defluoridation programs in fluoride endemic zones to combat the undesirable effects of fluoride