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

Main Article Content

Carlo Zocchetti

Keywords

Epidemiologic Health Impact Assessment; Attributable cases; Incremental Lifetime Cumulative Risk; Risk assessment

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.

Downloads

Download data is not yet available.
Abstract 326 | PDF Downloads 209

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
2. Dogliotti E, e coll: Linee guida per la valutazione di impatto sanitario (DL.vo 104/2017). Roma: Istituto Superiore di Sanità; 2019 (Rapporti ISTISAN 19/9)
3. https://va.minambiente.it/it-IT (last access on october, 5th 2021)
4. US EPA: Risk Assessment Guidance for Superfund (RAGS), Part A. Washington, US EPA, 1989
5. 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
6. https://www.airc.it/cancro/informazioni-tumori/corretta-informazione/inquinamento-atmosferico (last access on october, 5th 2021)
7. DM 24 aprile 2013: Disposizioni volte a stabilire i criteri metodologici utili per la redazione del rapporto di valutazione del danno sanitario (VDS) in attuazione dell’articolo 1 -bis , comma 2, del decreto-legge 3 dicembre 2012, n. 207, convertito, con modificazioni, dalla legge 24 dicembre 2012, n. 231)
8. Kleinbaum DG, Kupper LL, Morgenstern H: Epidemiologic Research, John Wiley & Sons, 1982
9. World Health Organization: Air Quality Guidelines for Europe. Second Edition. WHO Regional Publications, European Series No 91. Copenhagen, WHO, 2000
10. Schouten LJ, Straatman H, Kiemeney L, Verbeek A: Cancer incidence: life table risk versus cumulative risk. J Epidemiol Community Health 1994; 48(6): 596-600
11. World Health Organization Regional Office for Europe: Evaluation and use of epidemiological evidence for environmental health risk assessment. Guideline Document. Copenhagen, WHO Regional Office for Europe, 2000