Epidemiologic cohort studies have
consistently demonstrated that
long-term exposure to ambient fine particles (PM2.5) 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 PM2.5 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/m3 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.