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. 2022 Feb 22;113(1):e2022010.
doi: 10.23749/mdl.v113i1.12385.

Epidemiologic Health Impact Assessment: Estimation of Attributable Cases and Application to Decision Making

Carlo Zocchetti  1
Affiliations

Epidemiologic Health Impact Assessment: Estimation of Attributable Cases and Application to Decision Making

Carlo Zocchetti. Med Lav. .

Abstract

Objectives: The epidemiologic Health Impact Assessment (eHIA) process is receiving growing attention in Italy. In the context of such an approach, the present paper has three objectives: to review the computational aspects of eHIA for stressing strengths and weaknesses of methods and formulas; to discuss which rate at baseline could be used for the estimation of attributable cases; how to use the results of eHIA to make decisions regarding the realization of industrial projects.

Methods and results: Using a linear formulation of the relationship between exposure and disease occurrence: a) formulas have been derived to compute attributable cases (AC) using both Relative Risk (RR) and Excess Risk (ER) approaches; b) a discussion is made of the use as baseline rate of the rate that is caused by all the risk factors for a particular disease and a suggestion is made to use the rate that is caused simply by the risk factors that are under evaluation; c) under assumptions and approximations that must be validated in any specific situation, formulas are derived to compute Incremental Lifetime Cumulative Risk (ILCR), an indicator that can be used to compare the results coming from the eHIA approach with the levels of action used by USEPA and others (10-6, 10-5, 10-4). -Conclusion: In this paper, the methodology and the formulas commonly used in eHIA have been enlarged to consider the case in which the baseline rate is equal to zero, suggesting to use Excess Risk (ER) estimates instead of Relative Risk (RR) estimates. Using different baseline rates produces very different estimates of AC, and work needs to be done on this topic. Lastly, due to assumptions, approximations, and uncertainty of eHIA computations, prudence and caution should be exercised in using eHIA results in decision making, particularly if hard decisions have to be made.

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Figures

Figure 1.
Figure 1.
Graphic definition of the variables considered. Incidence rate
Figure 2.
Figure 2.
Graphic definition of the variables considered. Incidence rate with baseline rate RTD equal to 0
Figure 3.
Figure 3.
Graphic definition of the variables considered. Cumulative Incidence
See this image and copyright information in PMC

References

    1. Decreto legislativo 16 giugno 2017, n. 104: Attuazione della direttiva 2014/52/UE del Parlamento europeo e del Consiglio, del 16 aprile 2014, che modifica la direttiva 2011/92/UE, concernente la valutazione dell’impatto ambientale di determinati progetti pubblici e privati, ai sensi degli articoli 1 e 14 della legge 9 luglio 2015, n. 114. (17G00117). G.U. 6 luglio 2017, n. 156
    1. Dogliotti E, Achene E, Beccaloni E, et al. Linee guida per la valutazione di impatto sanitario (DL.vo 104/2017) Roma: Istituto Superiore di Sanità; 2019. (Rapporti ISTISAN 19/9)
    1. Ministero dell’Ambiente. https://va.minambiente.it/it-IT. (last access on October, 5th 2021)
    1. US EPA. Risk Assessment Guidance for Superfund (RAGS), Part A. Washington, US EPA, 1989
    1. Galise I, Serinelli M, Morabito A, et al. The Integrated Environmental Health Impact of emissions from a steel plant in Taranto and from a power plant in Brindisi, (Apulia Region, Southern Italy) Epidemiol Prev. 2019;43(5-6):329–337. - PubMed

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