Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation
OBJECTIVES Inhalation exposure to humidifier disinfectants has resulted to various types of health damages in Korea. To determine the epidemiological correlation necessary for presuming the legal causation, we aimed to develop a method to synthesize the entire evidence. METHODS Epidemiological and t...
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| Format: | Article |
| Language: | English |
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Korean Society of Epidemiology
2023-10-01
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| Series: | Epidemiology and Health |
| Subjects: | |
| Online Access: | http://www.e-epih.org/upload/epih-45-e2023095.pdf |
| _version_ | 1797305296896393216 |
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| author | Mina Ha Taehyun Park Jong-Hyun Lee Younghee Kim Jungyun Lim Yong-Wook Baek Sol Yu Hyen-Mi Chung Kyu Hyuck Chung Hae-Kwan Cheong Review Committee for the Epidemiological Correlations between Humidifier Disinfectants Exposure and Health Effects |
| author_facet | Mina Ha Taehyun Park Jong-Hyun Lee Younghee Kim Jungyun Lim Yong-Wook Baek Sol Yu Hyen-Mi Chung Kyu Hyuck Chung Hae-Kwan Cheong Review Committee for the Epidemiological Correlations between Humidifier Disinfectants Exposure and Health Effects |
| author_sort | Mina Ha |
| collection | DOAJ |
| description | OBJECTIVES Inhalation exposure to humidifier disinfectants has resulted to various types of health damages in Korea. To determine the epidemiological correlation necessary for presuming the legal causation, we aimed to develop a method to synthesize the entire evidence. METHODS Epidemiological and toxicological studies are systematically reviewed. Target health problems are selected by criteria such as frequent complaints of claimants. Relevant epidemiologic studies are reviewed and the risk of bias and confidence level of the total evidence are evaluated. Toxicological literature reviews are conducted on three lines of evidence including hazard information, animal studies, and mechanistic studies, considering the source-to-exposure-to-outcome continuum. The confidence level of the body of evidence is then translated into the toxicological evidence levels for the causality between humidifier disinfectant exposure and health effects. Finally, the levels of epidemiological and toxicological evidence are synthesized. RESULTS Under the Special Act revised in 2020, if the history of exposure and the disease occurred/worsened after exposure were approved, and the epidemiological correlation between the exposure and disease was verified, the legal causation is presumed unless the company proves the evidence against it. The epidemiological correlation can be verified through epidemiological investigations, health monitoring, cohort investigations and/or toxicological studies. It is not simply as statistical association as understood in judicial precedents, but a general causation established by the evidence as a whole, i.e., through weight-of-the-evidence approach. CONCLUSIONS The weight-of-the-evidence approach differs from the conclusive single study approach and this systematic evidence integration can be used in presumption of causation. |
| first_indexed | 2024-03-08T00:23:51Z |
| format | Article |
| id | doaj.art-6dbba312875e48f99c10c4521c778629 |
| institution | Directory Open Access Journal |
| issn | 2092-7193 |
| language | English |
| last_indexed | 2024-03-08T00:23:51Z |
| publishDate | 2023-10-01 |
| publisher | Korean Society of Epidemiology |
| record_format | Article |
| series | Epidemiology and Health |
| spelling | doaj.art-6dbba312875e48f99c10c4521c7786292024-02-16T01:04:25ZengKorean Society of EpidemiologyEpidemiology and Health2092-71932023-10-014510.4178/epih.e20230951458Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causationMina Ha0Taehyun Park1Jong-Hyun Lee2Younghee Kim3Jungyun Lim4Yong-Wook Baek5Sol Yu6Hyen-Mi Chung7Kyu Hyuck Chung8Hae-Kwan Cheong9Review Committee for the Epidemiological Correlations between Humidifier Disinfectants Exposure and Health Effects Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Korea Law School of Kangwon National University, Chuncheon, Korea EH R&C Co., Incheon, Korea Humidifier Disinfectant Health Center, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea Humidifier Disinfectant Health Center, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea Humidifier Disinfectant Health Center, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea Humidifier Disinfectant Health Center, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea Humidifier Disinfectant Health Center, Environmental Health Research Department, National Institute of Environmental Research, Incheon, Korea Sungkyunkwan University School of Pharmacy, Suwon, Korea Sungkyunkwan University School of Medicine, Suwon, KoreaOBJECTIVES Inhalation exposure to humidifier disinfectants has resulted to various types of health damages in Korea. To determine the epidemiological correlation necessary for presuming the legal causation, we aimed to develop a method to synthesize the entire evidence. METHODS Epidemiological and toxicological studies are systematically reviewed. Target health problems are selected by criteria such as frequent complaints of claimants. Relevant epidemiologic studies are reviewed and the risk of bias and confidence level of the total evidence are evaluated. Toxicological literature reviews are conducted on three lines of evidence including hazard information, animal studies, and mechanistic studies, considering the source-to-exposure-to-outcome continuum. The confidence level of the body of evidence is then translated into the toxicological evidence levels for the causality between humidifier disinfectant exposure and health effects. Finally, the levels of epidemiological and toxicological evidence are synthesized. RESULTS Under the Special Act revised in 2020, if the history of exposure and the disease occurred/worsened after exposure were approved, and the epidemiological correlation between the exposure and disease was verified, the legal causation is presumed unless the company proves the evidence against it. The epidemiological correlation can be verified through epidemiological investigations, health monitoring, cohort investigations and/or toxicological studies. It is not simply as statistical association as understood in judicial precedents, but a general causation established by the evidence as a whole, i.e., through weight-of-the-evidence approach. CONCLUSIONS The weight-of-the-evidence approach differs from the conclusive single study approach and this systematic evidence integration can be used in presumption of causation.http://www.e-epih.org/upload/epih-45-e2023095.pdfhumidifier disinfectantspresumption of causation weight-of-the-evidence approachsystematic reviewsevidence integration |
| spellingShingle | Mina Ha Taehyun Park Jong-Hyun Lee Younghee Kim Jungyun Lim Yong-Wook Baek Sol Yu Hyen-Mi Chung Kyu Hyuck Chung Hae-Kwan Cheong Review Committee for the Epidemiological Correlations between Humidifier Disinfectants Exposure and Health Effects Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation Epidemiology and Health humidifier disinfectants presumption of causation weight-of-the-evidence approach systematic reviews evidence integration |
| title | Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation |
| title_full | Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation |
| title_fullStr | Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation |
| title_full_unstemmed | Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation |
| title_short | Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation |
| title_sort | evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation |
| topic | humidifier disinfectants presumption of causation weight-of-the-evidence approach systematic reviews evidence integration |
| url | http://www.e-epih.org/upload/epih-45-e2023095.pdf |
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