A Transparent Method for Medicolegal Decision-Making: The FAIR Framework for Individualized Attribution in Occupational Disease.

Authors

Eytan Ellenberg, Akshaya Bhagavathula, Julie Cwikel, Nadav Davidovitch, Jalees Razavi, Eldad Katorza, Tee Guidotti

Published in

Journal of occupational and environmental medicine. Sep 14, 2026. Epub Sep 14, 2026.

Abstract

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.
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.
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%).
FAIR provides a transparent approach for translating epidemiologic evidence into threshold-aligned individual attribution in occupational disease assessment.

PMID:
42733156
Bibliographic data and abstract were imported from PubMed on 14 Sep 2026.

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