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

Abstract 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.