Department of Environmental Health, Harvard University T.H. Chan School of Public Health, Boston, Massachusetts 02115, United States.
Department of Environmental Health, Boston University School of Public Health, Boston, Massachusetts 02118, United States.
Environ Sci Technol. 2022 Jun 7;56(11):6799-6812. doi: 10.1021/acs.est.1c08343. Epub 2022 Apr 20.
Epidemiologic cohort studies have consistently demonstrated that long-term exposure to ambient fine particles (PM) is associated with mortality. Nevertheless, extrapolating results to understudied locations may involve considerable uncertainty. To explore this issue, this review discusses the evidence for (i) the associated risk of mortality, (ii) the shape of the concentration-response function, (iii) a causal interpretation, and (iv) how the source mix/composition of PM and population characteristics may alter the effect. The accumulated evidence suggests the following: (i) In the United States, the change in all-cause mortality risk per μg/m is about 0.8%. (ii) The concentration-response function appears nonlinear. (iii) Causation is overwhelmingly supported. (iv) Fossil fuel combustion-related sources are likely more toxic than others, and age, race, and income may modify the effect. To illustrate the use of our findings in support of a risk assessment in an understudied setting, we consider Kuwait. However, given the complexity of this relationship and the heterogeneity in reported effects, it is unreasonable to think that, in such circumstances, point estimates can be meaningful. Consequently, quantitative probabilistic estimates, which cannot be derived objectively, become essential. Formally elicited expert judgment can provide such estimates, and this review provides the evidence to support an elicitation.
流行病学队列研究一致表明，长期暴露于环境细颗粒物（PM）与死亡率有关。然而，将结果推断到研究较少的地区可能涉及相当大的不确定性。为了探讨这个问题，本综述讨论了以下方面的证据：（i）与死亡率相关的风险，（ii）浓度-反应函数的形状，（iii）因果关系的解释，以及（iv）PM 的源混合/组成和人口特征如何改变影响。积累的证据表明：（i）在美国，每微克/立方米的全因死亡率风险变化约为 0.8%。（ii）浓度-反应函数呈非线性。（iii）因果关系得到压倒性支持。（iv）与化石燃料燃烧有关的来源可能比其他来源更具毒性，年龄、种族和收入可能会改变这种影响。为了说明我们的研究结果在支持研究较少的环境中的风险评估中的应用，我们考虑了科威特。然而，鉴于这种关系的复杂性和报告的影响的异质性，认为在这种情况下，点估计可能有意义是不合理的。因此，不能客观推导的定量概率估计变得至关重要。正式征求专家意见可以提供此类估计，本综述提供了支持征求意见的证据。
