Filleul L, Medina S, Cassadou S
Laboratoire Santé Travail Environnement, 146, rue Léo-Saignat, 33076 Bordeaux.
Rev Epidemiol Sante Publique. 2003 Oct;51(5):527-42.
Major air pollution accidents which occurred in the 1950s led to public awareness of the health hazards involved. Since that period, levels of air pollution have decreased, but several studies conducted in North America and Europe indicate that particulate air pollution is linked to increased cardiorespiratory morbidity and mortality. Despite this evidence, several questions were raised concerning the interpretation of the results (threshold effect, harvesting effect and biological plausibility). The aim of this review is to present the link between epidemiological findings and their use in health impact assessment. We review the main causal criteria applied to epidemiology in light of scientific evidence currently available. Some causality criteria are more important than others, but they all support the causal nature of the relationship between air pollution and health, and thus justify the feasibility of health impact assessment calculations. Recent studies on relative risk assessment show that even if the risk linked to worsening air quality is low, public health consequences are high. Such information must be made accessible to policy makers and the population in general so that, together with the public health workers, they can all contribute to improving air quality and health in their communities.
20世纪50年代发生的重大空气污染事故使公众意识到其中涉及的健康危害。自那时以来,空气污染水平有所下降,但在北美和欧洲进行的几项研究表明,空气中的颗粒物污染与心肺疾病发病率和死亡率的增加有关。尽管有这些证据,但对于研究结果的解读仍存在一些问题(阈值效应、收获效应和生物学合理性)。本综述的目的是阐述流行病学研究结果与它们在健康影响评估中的应用之间的联系。我们根据目前可得的科学证据,回顾了应用于流行病学的主要因果标准。有些因果标准比其他标准更重要,但它们都支持空气污染与健康之间关系的因果性质,因此证明了健康影响评估计算的可行性。最近关于相对风险评估的研究表明,即使与空气质量恶化相关的风险很低,对公众健康的影响也很大。必须让政策制定者和普通民众都能获取此类信息,以便他们能与公共卫生工作者一道,共同为改善所在社区的空气质量和健康状况做出贡献。