Who Actually Dies from Indoor Air Pollution? A Forensic Perspective

In high-income countries, humans are continuously exposed to indoor and outdoor air pollution. Chronic exposure to these airborne solids and gases from natural or artificial sources is related to higher mortality. The objective of this work is to critically assess whether the association between indoor air pollution and death can support robust causal inference from a strict medico-legal perspective. We conducted a narrative review of existing literature on reported health consequences, autopsy and histopathological findings potentially linked to indoor air pollution exposure, and dose-response relationships and examined their role in criminal liability in Western countries. Despite prevention measures and regulations, establishing criminal liability for indoor air pollution remains arduous beyond a reasonable doubt given associative epidemiological evidence, translational biases, and non-specific autopsy findings. Further research on non-linear models and targeted forensic investigations is warranted.