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Int J Environ Res Public Health. 2017 Apr 7;14(4). pii: E389. doi: 10.3390/ijerph14040389.

An Overview of Literature Topics Related to Current Concepts, Methods, Tools, and Applications for Cumulative Risk Assessment (2007-2016).

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Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA.
Office of the Science Advisor, U.S. Environmental Protection Agency, Oak Ridge Institute for Science and Education (ORISE), Washington, DC 20004, USA.
Office of the Science Advisor, U.S. Environmental Protection Agency, Washington, DC 20004, USA.


Cumulative risk assessments (CRAs) address combined risks from exposures to multiple chemical and nonchemical stressors and may focus on vulnerable communities or populations. Significant contributions have been made to the development of concepts, methods, and applications for CRA over the past decade. Work in both human health and ecological cumulative risk has advanced in two different contexts. The first context is the effects of chemical mixtures that share common modes of action, or that cause common adverse outcomes. In this context two primary models are used for predicting mixture effects, dose addition or response addition. The second context is evaluating the combined effects of chemical and nonchemical (e.g., radiation, biological, nutritional, economic, psychological, habitat alteration, land-use change, global climate change, and natural disasters) stressors. CRA can be adapted to address risk in many contexts, and this adaptability is reflected in the range in disciplinary perspectives in the published literature. This article presents the results of a literature search and discusses a range of selected work with the intention to give a broad overview of relevant topics and provide a starting point for researchers interested in CRA applications.


chemical mixture; community health; cumulative risk assessment; ecological health; environmental justice; nonchemical stressor; vulnerable populations

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