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A Transparent Method for Medicolegal Decision-Making: The FAIR Framework for Individualized Attribution in
Eytan Ellenberg1, Akshaya Bhagavathula2, Julie Cwikel3
1National Insurance Institute, Office of Medical Affairs, Jerusalem, Israel.
Objective:
To present and evaluate Factor Attribution for Integrated Risk (FAIR), a framework for proportional attribution of excess disease risk in occupational medicine. FAIR aligns epidemiologic evidence with medicolegal thresholds (>50%, ≥20%) and distinguishes population-level causal evidence from case-level apportionment.
Methods:
FAIR integrates structured evidence appraisal, extraction of relative risks and baseline incidence, and Shapley value-based partitioning of excess risk across determinants. Attribution outputs are interpreted against medicolegal thresholds. The framework was applied to three exposure-disease pairs: mesothelioma, cutaneous squamous cell carcinoma, and bladder cancer.
Results:
FAIR reproduced established attribution hierarchies: asbestos >50%, occupational ultraviolet radiation 30-40%, and solvents 20-25%. Sensitivity analyses varying baseline incidence and model specification showed stable attribution (<±7%).
Conclusions:
FAIR provides a transparent approach for translating epidemiologic evidence into threshold-aligned individual attribution in occupational disease assessment.
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