Cumulative risk assessment for combined health effects from chemical and nonchemical stressors

Abstract

Cumulative risk assessment is a science policy tool for organizing and analyzing information to examine, characterize, and possibly quantify combined threats from multiple environmental stressors. We briefly survey the state of the art regarding cumulative risk assessment, emphasizing challenges and complexities of moving beyond the current focus on chemical mixtures to incorporate nonchemical stressors, such as poverty and discrimination, into the assessment paradigm. Theoretical frameworks for integrating nonchemical stressors into cumulative risk assessments are discussed, the impact of geospatial issues on interpreting results of statistical analyses is described, and four assessment methods are used to illustrate the diversity of current approaches. Prospects for future progress depend on adequate research support as well as development and verification of appropriate analytic frameworks.

FIGURE 1

Conceptual model for the combined effects of multiple stressors on health.

FIGURE 2

Conceptual model incorporating allostatic load with the combined effects of chemical and nonchemical stressors on health. Note. SES = socioeconomic status.