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Original research
Innovations in applied decision theory for health and safety
  1. David B Richardson1,
  2. Nathan L DeBono2,3,
  3. Colin Berriault3,
  4. Paul A Demers2,3
  1. 1Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA
  2. 2Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  3. 3Occupational Cancer Research Centre, Ontario Health, Toronto, Ontario, Canada
  1. Correspondence to Dr David B Richardson, Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, USA; david_richardson{at}


Objectives There are established methods for occupational epidemiological cohort analysis, such as proportional hazards regression, that are well suited to aetiological research and yield parameter estimates that allow for succinct communication among academics. However, these methods are not necessarily well suited for evaluation of health impacts of policy choices and communication to decision makers. An informed decision about a policy that impacts health and safety requires a valid estimate of the policy’s potential impact.

Methods We propose methods for data summarisation that may facilitate communication with managers, workers and their advocates. We calculate measures of effect in a framework for competing events, graphically display potential impacts on cause-specific mortality under policy alternatives and contrast these results to estimates obtained using standard Poisson regression methods. Methods are illustrated using a cohort mortality study of 28 546 Ontario uranium miners hired between 1950 and 1996 and followed through 2007.

Results A standard regression analysis yields a positive association between cumulative radon progeny exposure and all-cause mortality (log(RR per 100 WLM)=0.09; SE=0.02). The proposed method yields an estimate of the expected gain in life expectancy (approximately 6 months per worker) and reduction of 261 lung cancer deaths under a policy that eliminated occupational radon progeny exposure.

Conclusions The proposed method shifts attention from covariate-adjusted risk ratios or rate ratios to estimates of deaths that are avoided or delayed under a potential policy. The approach may help inform decision-making and strengthen the connection of epidemiological approaches to data analysis with developments in decision theory and systems engineering to improve health and safety.

  • mortality studies
  • radon
  • cancer
  • epidemiology
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  • Contributors DBR conceived of the project. NLD and CB conducted analyses. PAD is the principal investigator of the cohort study and contributed to interpretation of results and writing text. This paper is not being considered for publication elsewhere.

  • Funding This study was sponsored by the Alpha Foundation for the Improvement of Mine Safety and Health (ALPHA FOUNDATION). The views, opinions and recommendations expressed herein are solely those of the authors and do not imply any endorsement by the ALPHA FOUNDATION, its directors and staff. The Occupational Cancer Centre is funded by the Canadian Cancer Society, the Ontario Ministry of Labour and Cancer Care Ontario.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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