Assessment of the health effects of atmospheric sulfur oxides and particulate matter: evidence from observational studies.

Steadily rising energy costs have increased the need for reliable information on the health effects of atmospheric sulfur oxides and particulate matter. Because ethical and practical considerations limit studies of this question under controlled conditions, observational studies provide an important part of the relevant information. This paper examines the currently available epidemiologic evidence from population studies of the health effects of these pollutants. Nonexperimental studies also have important limitations, including the inability to measure accurately the exposure burden of free living individuals, and the potential for serious confounding by other factors affecting health. We begin with a discussion of some of these methodologic issues. The evidence is then reviewed, first in association with fluctuations in 24 hr mean concentration of sulfur oxides and particulate matter, and then in association with differences in mean annual concentration. In the last section, this evidence is summarized and used to approximate the exposure-response relationship linking pollutant concentrations with mortality and morbidity levels.