A standardised approach to systematically select risk-outcome pairs in environmental burden of disease research

BACKGROUND: Environmental Burden of Disease (EBoD) quantifies health impacts attributable to environmental risk factors. The methodological choice on which risk-outcome pairs to include in EBoD studies is technically and conceptually demanding, with diffuse exposures and complex causal chains. This makes transparent criteria for inclusion of risk-outcome pairs essential. In response, we developed a standardised approach for systematically and transparently selecting risk-outcome pairs within environmental burden of disease research. METHODS AND RESULTS: The standardised approach was developed through expert elicitation and iterative discussions, ultimately resulting in five sequential steps designed to strengthen consistency and transparency: (1) define and characterise the exposure to the environmental risk factor; (2) identify potential health outcomes from the literature; (3) evaluate the strength of evidence criteria according to set criteria; (4) select risk-outcome pairs based on strength of evidence; and (5) select exposure-response functions. CONCLUSIONS: By making underlying assumptions explicit, the proposed approach to the selection of risk-outcome pairs can reduce subjectivity in the selection process and support more consistent, evidence-based decisions.