Society For Risk Analysis Annual Meeting 2017

Session Schedule & Abstracts

* Disclaimer: All presentations represent the views of the authors, and not the organizations that support their research. Please apply the standard disclaimer that any opinions, findings, and conclusions or recommendations in abstracts, posters, and presentations at the meeting are those of the authors and do not necessarily reflect the views of any other organization or agency. Meeting attendees and authors should be aware that this disclaimer is intended to apply to all abstracts contained in this document. Authors who wish to emphasize this disclaimer should do so in their presentation or poster. In an effort to make the abstracts as concise as possible and easy for meeting participants to read, the abstracts have been formatted such that they exclude references to papers, affiliations, and/or funding sources. Authors who wish to provide attendees with this information should do so in their presentation or poster.

Common abbreviations

Symposium: Burden of Disease from Environmental Hazards in the Home and Community: Why? How? What? So What?

Room: Salon A   10:30 am–12:00 pm

Chair(s): Kevin Brand

Sponsored by Economics and Benefits Analysis Specialty Group

The environmental burden of disease (EBD) has been estimated in different regions of the world with the broadest definition of environmental as “everything except genetics”. The World Health Organization attributed 23% of all global deaths to modifiable environmental factors, while the corresponding estimate for several European countries was 3% to 7%. In both cases, air pollution, including fine particulate matter (PM2.5), figured prominently in the EBD. In 2015, Public Health Ontario (PHO), a Crown corporation dedicated to protecting and promoting the health of Ontarians and reducing inequities in health, began an effort to estimate the EBD for 40% of the Canadian population living in the province. The motivation for the EBD analysis was to promote effective environmental and public health decision making by policy makers and the public. During the first phase (completed August 2016), PHO collaborated with Cancer Care Ontario to identify exposure to sunlight, radon, and air pollution as the top contributors (over 90%) to the environmental burden of cancer in Ontario.1 In the second phase, PHO is focusing on non-cancer endpoints, ranging from asthma to premature death. Analyses are underway for air pollution and waterborne/foodborne illnesses, with other hazards to come (e.g., lead, mercury, pollen). This symposium will (1) motivate why a jurisdiction would consider conducting an EBD; (2) present methods, results, and challenges associated with select hazards of the EBD for Ontario; and (3) offer PHO’s experience and lessons learned in communicating the EBD findings to decision makers, the public, and the media, with a focus on the relative merits of different results metrics. The symposium will be relevant for public health/environmental/medical/consulting organizations conducting or considering EBD analyses at any scale, or anyone wishing to learn more about the general purpose, methods, and current applications of EBD projects.

W2-A.1  10:30 am  An overview of estimating the environmental burden of disease in Ontario, Canada . Greco SL*, Kim JH, MacIntyre E, Copes R; Public Health Ontario

Abstract: Public Health Ontario (PHO), a Crown corporation dedicated to protecting and promoting the health of the approximately 14 million residents of Ontario, is currently working to estimate the environmental burden of disease (EBD) for the province. In the first phase of the EBD project, PHO collaborated with Cancer Care Ontario to estimate the burden from exposure to 23 carcinogens, of which ultraviolet radiation, radon, and fine particulate matter (PM2.5) were the major contributors. The results are summarized in the “Environmental Burden of Cancer in Ontario” (2016). For the second phase, PHO will focus on 12 groups of hazards (e.g., air pollution, pathogens causing foodborne illness) associated with adverse health outcomes other than cancer. These outcomes range in severity from allergic rhinitis to premature death. Challenges with the “non-cancer” EBD estimation for Ontario include: selecting hazards in the absence of internationally accepted classification schemes for adverse health endpoints outside of cancer; determining valid hazard-outcome pairings; developing specific analysis plans for a large number of pairings; and deciding upon and developing an appropriate metric to convey the results to decision-makers, the public, and the media. Robust data are a strength of the EBD estimation: extensive health records are available for nearly all residents of the province (e.g., physician office visits, hospitalizations, deaths) and environmental monitoring data are available to help assess exposure. This presentation will provide an overview of the entire EBD project for Ontario, present the findings from the cancer burden phase of the project, and discuss the approach for the non-cancer burden phase. (Report available at BrowseByTopic/EnvironmentalandOccupationalHealth/ Pages/Environmental-Burden-of-Cancer-ON.aspx)

W2-A.2  10:50 am  Estimating the burden of foodborne and waterborne illness in Ontario . Kim JH*, Greco SL, Copes R; Public Health Ontario

Abstract: Public Health Ontario (PHO), an arms-length government agency, is dedicated to protecting and promoting the health of the people of Ontario, who comprise approximately 40% of Canadians. As part of a project to estimate the environmental burden of disease for the province of Ontario, we produced estimates for foodborne and waterborne illness. For our population and project objectives, we adapted the approach used by the World Health Organization to estimate the global burden of foodborne disease. Essentially, foodborne and waterborne attributions (%) were applied to pathogen-based health outcome data to estimate the burden due to each source of illness. The attributions were based on previously conducted expert elicitations, while health outcome data were extracted from administrative databases containing healthcare utilization information for nearly everyone in the province. Specifically, data on physician office visits, emergency room visits, hospitalizations, and deaths (for health outcomes defined by ICD-9 or ICD-10 codes) were used. We selected the top 12 foodborne and top 11 waterborne pathogens to be analysed based on surveillance data and additional data sources as needed. In addition to estimating the burden due to specific pathogens (e.g., giardiasis, norovirus infection), we also estimated the foodborne and waterborne disease burden due to more general diagnoses (syndrome-based) such as gastroenteritis (i.e., “stomach flu). This presentation will describe our methods and preliminary results, as well as discuss the strengths and limitations associated with the analysis.

W2-A.3  11:10 am  Population Health Impact Estimates: Unplugged . Brand KP*, Lin Z; University of Ottawa

Abstract: A variety of yardsticks are available for measuring the health of populations. These in turn form the basis for quantifying health impacts, as in Environmental Burden of Disease (EBD) enterprises. Two broad classes of yardstick prevail including Health expectancy (HE) measures (e.g., Health Adjusted Life Expectancy) and Health Gap (HG) measures (e.g., Disability Adjusted life Expectancy). Whereas HE measures can be conceptualized as focusing on the proverbial `glass half full’ (counting how much a health a population enjoys), their HG counterparts focus on the `glass half empty’ (counting up how a population’s health state falls short of a specified norm). The algorithms for computing these measures can be quite onerous and data-intensive. The barriers to entry may on occasion discourage public health decision makers from capitalizing on such “bottom line” yardsticks, but perhaps more importantly may occlude (through their complexity) knowledge translation efforts. Ongoing work demonstrates that health impacts expressed in either class (HE or HG) of measure can be approximated by a reduced set of inputs (e.g., the status-quo incidence-rate of the event being perturbed by the risk factor of interest). The key inputs are intuitive. Moreover they combine together intuitively taking on the form: impact=likelihood x consequence (echoing a definition of risk). The heuristics for computing HG and HE measures are demonstrated (using data from the Human Mortality Database; Attention in this work is restricted to the case where Mortality dominates morbidity. The promise of the heuristics for enabling/extending knowledge translation efforts is highlighted.

W2-A.4  11:30 am  Communicating the results of an environmental health burden to decision-makers, the public, and the media . Copes R*; Public Health Ontario

Abstract: Estimating the burden of disease attributable to various risk factors, whether environmental or behavioural, can help provide a useful context for priority setting and policy making. The metrics used to express the burden must be understandable and “important” to the target audience, who may include policy makers in distinct sectors (e.g., health, environment, labor), health professionals, the public, and the media. There will also be significant differences in terms of which metrics work best for target audiences at the international, national and subnational scales. Furthermore, certain metrics for expressing burden (e.g., disability-adjusted life years or DALYs, deaths, adverse health outcomes and their associated costs) may work better at influencing some audiences than others. This presentation will discuss some of the metrics used to summarize burden of disease estimates, as well as their advantages and disadvantages with respect to influencing specific target audiences. The presentation will also summarize the published materials (e.g., report, infographic, technical supplement) and selected metrics used in the “Environmental Burden of Cancer in Ontario” report released in 2016 by Public Health Ontario and Cancer Care Ontario, and discuss the lessons learned in communicating the results of this report. (Report available at /BrowseByTopic/EnvironmentalandOccupationalHealth /Pages/Environmental-Burden-of-Cancer-ON.aspx)

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