Air Pollution and Health: Correlation or Causality? The Case of the Relationship between Exposure to Particles and Cardiopulmonary Mortality

ABSTRACT William Dab (M.D., Ph.D.) was responsible for the project as the general representative of the APPA. Claire Ségala (M.D., MPH, SEPIA) was the main researcher. The other members of the working group are Frédéric Dor (Ph.D., Institut de Veille Sanitaire), Bernard Festy (president of the APPA), Philippe Lameloise (AIRPARIF), Yvon Le Moullec (Laboratoire d'Hygiène de la Ville de Paris), Alain Le Tertre (MSc, Institut de Veille Sanitaire), Sylvia Médina (M.D., MSc, Institut de Veille Sanitaire), Philippe Quénel (M.D., Ph.D., Institut de Veille Sanitaire), Benoît Wallaert (PU-PH, Faculté de Médecine de Lille) and Denis Zmirou (M.D., Ph.D., MCU-PH Faculté de Médecine de Grenoble). Many epidemiologic studies have observed, in different contexts, a slight short-term relationship between particles in air and cardiopulmonary mortality, even when air quality standards were respected. The causality of this relationship is important to public health because of the number of people exposed. Our aim was to make a critical assessment of the arguments used in 15 reviews of published studies. We explain the importance of distinguishing validity from causality, and we systematically analyze the various criteria of judgment within the context of ecologic time studies. Our conclusion is that the observed relationship is valid and that most of the causality criteria are respected. It is hoped that the level of exposure of populations to these particles be reduced. In Europe, acting at the root of the problem, in particular on diesel emissions, will also enable the reduction of levels of other pollutants that can have an impact on health. In the United States, the situation is more complicated, as particles are mainly secondary. It is also essential to continue with research to become better acquainted with the determinants of personal global exposures and to better understand the toxic role of the various physicochemical factors of the particles.

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