Transcript Geen diatitel

Quantifying Health Risks
L.G.H. Koren & J.E.M.H. van Bronswijk
Eindhoven University of Technology
Background information for Assignment 3
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Health risk analysis
Individual Health
• Individual Exposure Assessment
• Medical Diagnosis
Public Health
• Exposure Assessment
• Incidence of Nuisance, Stress or Disease
• Prevalence of Nuisance, Stress or Disease
• Chain Model Risk Analysis
• DALY’s (Disability Adjusted Life Years)
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Individual-Health Risk Analysis
Individual Exposure Assessment
•
Personal samplers (physical and chemical agents)
Medical Diagnosis
•
•
•
A disease may be caused by a number of agents
One agent may cause a number of diseases
Preventive medicine: when belonging to a risk
group
Design of Built Environments
•
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Safety implications
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Public Health Risk Analysis
Exposure Assessment
•(Continuous) measurements of markers or noxious agents
•Relation with health is proven elsewhere
Incidence of Nuisance, Stress or Disease
•Number of new cases diagnosed in 1 year
•Relevant for safety of built environments
Prevalence of Nuisance, Stress or Disease
•Number of cases known in 1 year or life span
•Relevant for sustainable comfort of built environments
Chain Model Risk Analysis
•Process analysis (OHS approach)
•For stepwise improvement
DALY’s (Disability Adjusted Life Years)
•Healthy years in a life span calculation
•For comparison of health results of different designs
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Chain Model Risk Analysis
• Method of Choice in OHS (Occupational
Health and Safety)
• Estimates probability, severity and damage
of incidents
• Used for risks of water, air, fire, burglary,
socio-economic living conditions, leisure and
occupational activities
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Chain model risk analysis
Risk of health damage
from pathogenic
organisms in water
•
•
•
•
Identify sources
Estimate emission
Estimate exposure
Estimate risk of disease
• Evaluate acceptability
Risk of health damage
from flaws in construction
•
•
•
•
Identify risk areas
Estimate calamity limits
Estimate calamity effects
Estimate calamity chances
• Evaluate acceptability
Example: Versteegh et al. 1997:
http://www.rivm.nl/bibliotheek/rapporten/289202019.html
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2nd Quality Water in Dwellings
•An experimental, environmental measure
•Risk Sources: shower, washing machine, WC, bath,
outdoor tap; frequency of use, liters used
• Emission: pathogens Campylobacter, Salmonella, E. coli,
different viral agents; range of organisms per liter, doseresponse curve
• Exposure: swallowing, inhaling; estimated amounts in
ml
• Risk of disease: worst-case approach: use of every
range the most disadvantageous end
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nd
2
Quality Water Use
A Risk Example
Use of 2nd quality water has recently been discouraged
by the national Netherlands government
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DALY: Disability-Adjusted Life
Years
• Long term health effects
• Premature death (= lost years) +
• Lost vitality (=burden of existing disease)
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Total burden of disease
=
Number of lost years (weight = 1 for each lost year)
+
Years with disability (weight = 0.01-0.99 / year depending
on disease burden)
Source: http://www.rivm.nl/nationaalkompas/data/gezondheidstoestand/svm/daly/daly_ziektelast.htm
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DALY calculations
• Weighing factors based upon the burden of the
disease
• Weighing factors differ for the different stages or
severities of the disease
• All based upon (incomplete) medical registration
of cases
• Currently 52 diseases are weighed (because of
their relative importance), the list will grow
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Building-related diseases and DALY’s in the Netherlands
Burden of disease in:
Disease
Lost years
A
Prevalence /
incidence
B
Gravity
(weighing
factor)
C
Burden of
disease in
DALY's
(=A+BxC)
Asthma
1.742
444.900
0,08
37.334
Atopic dermatitis
<1
160.900
0,07
11.263
COPD (bronchitis + lung
emphysema)
58.175
289.500
0,31
147.920
Coronary diseases I
186.746
556.600
0,29
348.160
Extrinsic allergic
alveolitis
<1
200
0,3
60
Mycoses
<1
200
0,2
40
Lung cancer I
119.607
19.900
0,44
128.363
Lung infections
(pleuritis)
49.448
638.600
0,04
74.992
Totaal
418.151
2.516.330
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758.847
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Examples for a DALY
Calculation
Take a Person with a life expectancy of 75
years:
- S/he dies at age 58 from a fall
- S/he dies at 75 with rheuma (weighing
factor 0.5) since age 41
- S/he dies at age 65 with mild diabetes
(weighing factor 0.2) since age 30
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DALY calculation sheet
Burden of disease in:
Disease
Lost years
A
Prevalence
/ incidence
B
Gravity
(weighing
factor)
C
Burden
of
disease
in
DALY's
Percentage
buildingrelated
Buildingrelated
burden of
disease in
DALY's
70%
26.134
20%
2.253
Asthma
1.742
444.900
0,08
Atopic dermatitis
<1
160.900
0,07
37.334
(=A+BxC
)
11.263
COPD (bronchitis +
lung emphysema)
58.175
289.500
0,31
147.920
10%
14.792
Coronary diseases I
186.746
556.600
0,29
348.160
5%
17.408
Extrinsic allergic
alveolitis
<1
200
0,3
60
10%
6
Mycoses
<1
200
0,2
40
10%
4
Lung cancer I
119.607
19.900
0,44
128.363
4%
5.135
Lung infections
(pleuritis)
49.448
638.600
0,04
74.992
5%
3.750
Totaal
418.151
2.516.330
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758.847
70.094
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Estimated Health Effects (in DALY’s) of
Ventilation Systems
Asthma /
dermatitis
COPD
1585
2761
922
>5264
A1
500
700
300
1500
A2 (with chimneys)
500
700
300
1500
A3 grids autoregulated
85
61
22
164
C1 constant
500
1300
300
2100
C2 adaptive




C3 hybride
(natural/adaptive)




D1 constant




D2 adaptive




D3 adaptive heat recovery




D4 hybrid (natural/adaptive)




Ventilation system
DALY’s in 1994 (systems in
use mainly A1,A2,C1)
Lung
Totaal
cancer
Naturally ventilated
Mechanical ventilation C
Mechanical ventilation D
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Health effects (in DALYs) of different energy-reducing building
and installation measures
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