Fang, X ∙ Fry, DA ∙ Brown, DS ∙ et al. However, a 2019 study estimated the annual burden of ACE exposure across ten risk factors for, and causes of, ill health to be US$581 billion in Europe and $748 billion in North America; equivalent to 2·7% of Europe's and 3·5% of North America's gross domestic product (GDP).