NDLI: Estimating risk factor attributable burden – challenges and potential solutions when using the comparative risk assessment methodology

Content Provider	Springer Nature : BioMed Central
Author	Plass, Dietrich Hilderink, Henk Lehtomäki, Heli Øverland, Simon Eikemo, Terje A. Lai, Taavi Gorasso, Vanessa Devleesschauwer, Brecht
Abstract	Background Burden of disease analyses quantify population health and provide comprehensive overviews of the health status of countries or specific population groups. The comparative risk assessment (CRA) methodology is commonly used to estimate the share of the burden attributable to risk factors. The aim of this paper is to identify and address some selected important challenges associated with CRA, illustrated by examples, and to discuss ways to handle them. Further, the main challenges are addressed and finally, similarities and differences between CRA and health impact assessments (HIA) are discussed, as these concepts are sometimes referred to synonymously but have distinctly different applications. Results CRAs are very data demanding. One key element is the exposure-response relationship described e.g. by a mathematical function. Combining estimates to arrive at coherent functions is challenging due to the large variability in risk exposure definitions and data quality. Also, the uncertainty attached to this data is difficult to account for. Another key issue along the CRA-steps is to define a theoretical minimal risk exposure level for each risk factor. In some cases, this level is evident and self-explanatory (e.g., zero smoking), but often more difficult to define and justify (e.g., ideal consumption of whole grains). CRA combine all relevant information and allow to estimate population attributable fractions (PAFs) quantifying the proportion of disease burden attributable to exposure. Among many available formulae for PAFs, it is important to use the one that allows consistency between definitions, units of the exposure data, and the exposure response functions. When combined effects of different risk factors are of interest, the non-additive nature of PAFs and possible mediation effects need to be reflected. Further, as attributable burden is typically calculated based on current exposure and current health outcomes, the time dimensions of risk and outcomes may become inconsistent. Finally, the evidence of the association between exposure and outcome can be heterogeneous which needs to be considered when interpreting CRA results. Conclusions The methodological challenges make transparent reporting of input and process data in CRA a necessary prerequisite. The evidence for causality between included risk-outcome pairs has to be well established to inform public health practice.
Related Links	https://archpublichealth.biomedcentral.com/counter/pdf/10.1186/s13690-022-00900-8.pdf
Ending Page	12
Page Count	12
Starting Page	1
File Format	HTM / HTML
ISSN	20493258
DOI	10.1186/s13690-022-00900-8
Journal	Archives of Public Health
Issue Number	1
Volume Number	80
Language	English
Publisher	BioMed Central
Publisher Date	2022-05-27
Access Restriction	Open
Subject Keyword	Public Health Medicine Health Policy Health Services Research Health Informatics Burden of disease (BoD) Comparative risk assessment (CRA) Disability-adjusted life years (DALY) Health impact assessment (HIA) Population health Medicine/Public Health
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health
Journal Impact Factor	3.2/2023
5-Year Journal Impact Factor	3.3/2023

Sl.	Authority	Responsibilities	Communication Details
1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
2	Indian Institute of Technology Kharagpur	Host Institute of the Project: The host institute of the project is responsible for providing infrastructure support and hosting the project	https://www.iitkgp.ac.in
3	National Digital Library of India Office, Indian Institute of Technology Kharagpur	The administrative and infrastructural headquarters of the project	Dr. B. Sutradhar bsutra@ndl.gov.in
4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
5	Website/Portal (Helpdesk)	Queries regarding NDLI and its services	support@ndl.gov.in
6	Contents and Copyright Issues	Queries related to content curation and copyright issues	content@ndl.gov.in
7	National Digital Library of India Club (NDLI Club)	Queries related to NDLI Club formation, support, user awareness program, seminar/symposium, collaboration, social media, promotion, and outreach	clubsupport@ndl.gov.in
8	Digital Preservation Centre (DPC)	Assistance with digitizing and archiving copyright-free printed books	dpc@ndl.gov.in
9	IDR Setup or Support	Queries related to establishment and support of Institutional Digital Repository (IDR) and IDR workshops	idr@ndl.gov.in

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