Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation

• 영문명: Evidence integration on health damage for humidifier disinfectant exposure and legal presumption of causation
• 발행기관: 한국역학회
• 저자명: 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
• 간행물 정보: 『Epidemiology and Health』45, 1~14쪽, 전체 14쪽
• 주제분류: 의약학 > 면역학
• 파일형태: PDF
• 발행일자: 2023.01.01

영문 초록

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.

목차

INTRODUCTION

PUBLICATION PROCEDURE OF REVIEW REPORTS ON EPIDEMIOLOGICAL CORRELATIONS

SCIENTIFIC EVIDENCE INTEGRATION PROCEDURE FOR VERIFYING EPIDEMIOLOGICAL CORRELATION

PROOF OF CAUSATION BY SYSTEMATICALLY EVALUATING AND INTEGRATING SCIENTIFIC EVIDENCE UNDER THE SPECIAL ACT

DISCUSSION

CONCLUSION

SUPPLEMENTARY MATERIALS

CONFLICT OF INTEREST

FUNDING

ACKNOWLEDGEMENTS

AUTHOR CONTRIBUTIONS

ORCID

REFERENCES

키워드

Humidifier disinfectants Presumption of causation Epidemiological correlation Weight-of-the-evidence approach Systematic reviews Evidence integration