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The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project

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Abstract

Public decision-makers commonly use health impact assessments (HIA) to quantify the impacts of various regulation policies. However, standard HIAs do not consider that chronic diseases (CDs) can be both caused and exacerbated by a common factor, and generally focus on exacerbations. As an illustration, exposure to near road traffic-related pollution (NRTP) may affect the onset of CDs, and general ambient or urban background air pollution (BP) may exacerbate these CDs. We propose a comprehensive HIA that explicitly accounts for both the acute effects and the long-term effects, making it possible to compute the overall burden of disease attributable to air pollution. A case study applies the two HIA methods to two CDs—asthma in children and coronary heart disease (CHD) in adults over 65—for ten European cities, totaling 1.89 million 0–17-year-old children and 1.85 million adults aged 65 and over. We compare the current health effects with those that might, hypothetically, be obtained if exposure to NRTP was equally low for those living close to busy roads as it is for those living farther away, and if annual mean concentrations of both PM10 and NO2—taken as markers of general urban air pollution—were no higher than 20 μg/m3. Returning an assessment of € 0.55 million (95 % CI 0–0.95), the HIA based on acute effects alone accounts for only about 6.2 % of the annual hospitalization burden computed with the comprehensive method [€ 8.81 million (95 % CI 3–14.4)], and for about 0.15 % of the overall economic burden of air pollution-related CDs [€ 370 million (95 % CI 106–592)]. Morbidity effects thus impact the health system more directly and strongly than previously believed. These findings may clarify the full extent of benefits from any public health or environmental policy involving CDs due to and exacerbated by a common factor.

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References

  1. Dannenberg, A.L., Bhatia, R., Cole, B.L., et al.: Use of health impact assessment in the U.S. 27 case studies, 1999–2007. Am. J. Prev. Med. 34(3), 241–256 (2008)

    Article  PubMed  Google Scholar 

  2. World Health Organization: Health impact assessment special theme issue. Bull. World Health Organiz. 6, 387–472 (2003)

    Google Scholar 

  3. Krupnick, A., Portney, P.R.: Controlling urban air pollution: a benefit-cost assessment. Science 252(5005), 522–528 (1991)

    Article  CAS  PubMed  Google Scholar 

  4. Künzli, N., Kaiser, R., Medina, S., et al.: Public-health impact of outdoor and traffic-related air pollution: a European assessment. Lancet 356(9232), 795–801 (2000)

    Article  PubMed  Google Scholar 

  5. Hoek, G., Brunekreef, B., Goldbohm, S.: Association between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study. Lancet 360(9341), 1203–1219 (2002)

    Article  PubMed  Google Scholar 

  6. Medina, S., Ballester, F., Chanel, O., et al.: Quantifying the health impacts of outdoor air pollution: useful estimations for public health action. J. Epidemiol. Community Health 67, 480–483 (2013)

    Article  PubMed  Google Scholar 

  7. Holland, M., Hurley, F., Hunt, A., et al.: Methodology for the Cost-Benefit Analysis for CAFE: volume 3: Uncertainty in the CAFE CBA. Report ED51014 AEA Technology Environment Report, Oxon (2005)

  8. Holland, M.: Cost-benefit analysis of final policy scenarios for the EU Clean Air package. Version 2 Corresponding to IIASA TSAP Report #11, Version 1, March, 67p., http://www.iiasa.ac.at/web/home/research/researchPrograms/MitigationofAirPollutionandGreenhousegases/TSAP_CBA_corresponding_to_IIASA11_v2.pdf (2014). Accessed 10 December 2014

  9. Health Effect Institute: Panel on the health effects of traffic-related air pollution. Traffic-related air pollution: A critical review of the literature on emissions, exposure, and health effects. HEI Special Report 17 Health Effects Institute, Boston (2010)

  10. Hoffmann, B., Moebus, S., Stang, A., et al.: Residence close to high traffic and prevalence of coronary heart disease. Eur. Heart J. 27, 2696–2702 (2006)

    Article  PubMed  Google Scholar 

  11. McConnell, R., Islam, T., Shankardass, K., et al.: Childhood incident asthma and traffic-related air pollution at home and school. Environ. Health Perspect. 118, 1021–1026 (2010)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Adar, S.D., Sheppard, L., Vedal, S., et al.: Fine particulate air pollution and the progression of carotid intima-medial thickness: a prospective cohort study from the multi-ethnic study of atherosclerosis and air pollution. PLoS Med. 10(4), e1001430 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  13. Anderson, H., Favarato, G., Atkinson, R.: Long-term exposure to air pollution and the incidence of asthma: meta-analysis of cohort studies. Air Qual. Atmos. Health 6(1), 47–56 (2013)

    Article  CAS  Google Scholar 

  14. Rivera, M., Basagaña, X., Aguilera, I., et al.: Association between long-term exposure to traffic-related air pollution and subclinical atherosclerosis: the REGICOR study. Environ. Health Perspect. 121, 223–230 (2013)

    PubMed  Google Scholar 

  15. Künzli, N., Perez, L., Lurmann, F., et al.: An attributable risk model for exposures assumed to cause both chronic disease and its exacerbations. Epidemiol. 19(2), 179–185 (2008)

    Article  Google Scholar 

  16. Perez, L., Künzli, N., Avol, E., et al.: Global goods movement and the local burden of childhood asthma in Southern California. Am. J. Public Health 99(Suppl 3), S622–S628 (2009)

    Article  PubMed  PubMed Central  Google Scholar 

  17. Brandt, S., Perez, L., Künzli, N., et al.: Costs of childhood asthma due to traffic-related pollution in two California communities. Eur. Resp. J. 40, 363–370 (2012)

    Article  Google Scholar 

  18. Perez, L., Declercq, C., Iñiguez, C., et al.: Chronic burden of near-roadway traffic pollution in 10 European cities (APHEKOM network). Eur. Resp. J. 42(3), 594–605 (2013)

    Article  Google Scholar 

  19. Aphekom: Guidelines of methods for integrating chronic effects of local-traffic pollution in the air pollution health impact methodology, Deliverable D3, http://www.aphekom.org/c/document_library/get_file?uuid=0e2a713d-7407-40ed-923a-1bb48450f75e&groupId=10347 (2011). Accessed 10 December 2014

  20. McConnell, R., Berhane, K., Yao, L., et al.: Traffic, susceptibility, and childhood asthma. Environ. Health Perspect. 114, 766–772 (2006)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Atkinson, R.W., Anderson, H.R., Sunyer, J., et al.: Acute effects of particulate air pollution on respiratory admissions: Results from APHEA 2 project. Air pollution and health: a European approach. Am. J. Respir. Cri. Care Med. 164((10 Pt 1)), 1860–1866 (2001)

    Article  CAS  Google Scholar 

  22. Andersen, Z.J., Wahlin, P., Raaschou-Nielsen, O., et al.: Size distribution and total number concentration of ultrafine and accumulation mode particles and hospital admissions in children and the elderly in Copenhagen, Denmark. Occup. Environ. Med. 65, 458–466 (2008)

    Article  CAS  PubMed  Google Scholar 

  23. D’Ippoliti, D., Forastiere, F., Ancona, C., et al.: Air pollution and myocardial infarction in Rome: a case-crossover analysis. Epidemiology 14, 528–535 (2003)

    Article  PubMed  Google Scholar 

  24. Lanki, T., Pekkanen, J., Aalto, P., et al.: Associations of traffic-related air pollutants with hospitalisation for first acute myocardial infarction: the HEAPSS study. Occup. Environ. Med. 63, 844–851 (2006)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Poloniecki, J.D., Atkinson, R.W., de Leon, A.P., et al.: Daily time series for cardiovascular hospital admissions and previous day’s air pollution in London, UK. Occup. Environ. Med. 54, 535–540 (1997)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Barnes, P.J., Jonsson, B., Klim, J.B.: The costs of asthma. Eur. Resp. J. 9, 636–642 (1996)

    Article  CAS  Google Scholar 

  27. Akobundu, E., Ju, J., Blatt, L., Mullins, C.D.: Cost-of-illness studies. A review of current methods. Pharmacoecon. 24(9), 869–890 (2006)

    Article  Google Scholar 

  28. World Bank database: World Development Indicators and Global Development Finance. http://databank.worldbank.org/ddp/home.do (2010). Accessed 7 February 2014

  29. Chanel, O.: Guidelines on monetary cost calculations related to air-pollution health impacts. Aphekom project. Deliverable D6, April, p. 45. http://www.aphekom.org/c/document_library/get_file?uuid=9432004a-0d17-4be9-8f86-5b33a77a12c4&groupId=10347 (2011). Accessed 20 Sept 2015

  30. Ungar, W.J., Coyte, P.C.: Pharmacy medication monitoring program advisory B: prospective study of the patient-level cost of asthma care in children. Pediatr. Pulmonol. 32(2), 101–108 (2011)

    Article  Google Scholar 

  31. Lozano, P., Sullivan, S.D., Smith, D.H., et al.: The economic burden of asthma in US children: estimates from the National Medical Expenditure Survey. J. Allergol. Clin. Immunol. 104(5), 957–963 (1999)

    Article  CAS  Google Scholar 

  32. Paternoster, A.: Annual Gross Earnings: Results from Member States, Acceding and Candidature Countries, and Switzerland. Tech. Rep. Eurostat-Theme 3-25 Eurostat, Luxembourg (2003)

  33. Brandt, S., Vásquez, F., Hanemann, M.: Designing contingent valuation scenarios for environmental health: the case of childhood asthma. UDEC DT 11-09, Universidad de Conception, 35 p (2008)

  34. Blomquist, G., Dickie, M., O’Conor, R.: Willingness to pay for improving fatality risks and asthma symptoms: values for children and adults of all ages. Ressour. Energ. Econ. 33(2), 410–425 (2011)

    Article  Google Scholar 

  35. Liu, J.L.Y., Maniadakis, N., Gray, A., Rayner, M.: The economic burden of coronary heart disease in the UK. Heart 88, 597–603 (2002)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Aliaga, C., Romans, F.: The Employment of Seniors in the European Union Statistics in Focus. Tech Rep Eurostat 15 Eurostat, Luxembourg (2006)

  37. Groot, W., Van Den Brink, H.M., Plug, E.: Money for health: the equivalent variation of cardiovascular diseases. Health Econ. 13(9), 859–872 (2004)

    Article  PubMed  Google Scholar 

  38. Kartman, B., Andersson, F., Johannesson, M.: Willingness to pay for reductions in angina pectoris attacks. Med. Decis. Mak. 16(3), 248–253 (1996)

    Article  CAS  Google Scholar 

  39. Organisation for Economic Co-operation and Development: Health Data CD-Rom. OECD, Paris (2010)

    Google Scholar 

  40. Commission of the European Communities: Commission Staff Working Document Accompanying the Proposal for a Council Recommendation on Patient Safety, Including the Prevention and Control of Healthcare Associated Infections—Impact Assessment. Tech Rep. SEC(2008)-3004 Council of the European Union, Brussels (2008)

  41. Ready, R., Navrud, S., Day, B., et al.: Benefit transfer in Europe: How reliable are transfers across countries? Environ. Resour. Econ. 29, 67–82 (2004)

    Article  Google Scholar 

  42. Sommer, H., Seethaler, R., Chanel, O., et al.: Health costs due to road traffic-related air pollution, an impact assessment project of Austria, France and Switzerland, Economic Valuation. Tech. Rep. WHO-TEH07 Ecoplan, Bern (1999)

  43. Leal, J., Luengo-Fernández, R., Gray, A., et al.: Economic burden of cardiovascular diseases in the enlarged European Union. Eur. Heart J. 27(13), 1610–1619 (2006)

    Article  PubMed  Google Scholar 

  44. Chan, W.C., Wright, C., Tobias, M., et al.: Explaining trends in coronary heart disease hospitalisations in New Zealand: trend for admissions and incidence can be in opposite directions. Heart 94(12), 1589–1593 (2008)

    Article  CAS  PubMed  Google Scholar 

  45. Tétreault, L.-F., Perron, S., Smargiassi, A.: Cardiovascular health, traffic-related air pollution and noise: are associations mutually confounded? A systematic review. Int. J. Public Health 58, 649–666 (2013)

    Article  PubMed  PubMed Central  Google Scholar 

  46. Vienneau, D., Perez, L., Schindler, C., et al.: Years of life lost and morbidity cases attributable to transportation noise and air pollution: a comparative health risk assessment for Switzerland in 2010. Int. J. Hygiene and Environ. Health 218(6), 514–521 (2015)

    Article  Google Scholar 

  47. Burmaster, D.E., Anderson, P.D.: Principles of good practice for the use of Monte Carlo techniques in human health and ecological risk assessment. Risk Anal. 14, 477–481 (1994)

    Article  CAS  PubMed  Google Scholar 

  48. Chanel, O., Henschel, S., Goodman, P., et al.: Health impacts and costs associated with the implementation of a EC regulation on SO2 in 20 European cities of the Aphekom project. Eur. J. Public Health 24(4), 631–637 (2014)

    Article  PubMed  Google Scholar 

  49. Héroux, M.-E., Anderson, H.R., Atkinson, R., et al.: Quantifying the health impacts of ambient air pollutants: recommendations of a WHO/Europe project. Int. J. Public Health 60(5), 619–627 (2015)

    Article  PubMed  PubMed Central  Google Scholar 

  50. Brandt, S., Perez, L., Künzli, N., et al.: Cost of near-roadway and regional air pollution-attributable childhood asthma in Los Angeles County. J. Allergy Clin. Immunol. 134, 1028–1035 (2014)

    Article  PubMed  PubMed Central  Google Scholar 

  51. Holland, M., Wagner, A., Hurley, F., et al.: Cost benefit analysis for the revision of the national emission ceilings directive. Report to European Commission, ED4778 (2011)

  52. U.S. Environmental Protection Agency: The Benefits and Costs of the Clean Air Act from 1990 to 2020. Final report Rev A. Agency office of air and radiation. Washington, DC: EPA. http://www.epa.gov/air/sect812/feb11/fullreport_rev_a.pdf (2011). Accessed 17 February 2014

  53. Raaschou-Nielsen, O., Andersen, Z., Beelen, R., et al.: Air pollution and lung cancer incidence in 17 European cohorts: prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE). Lancet Oncol. 14(9), 813–822 (2013)

    Article  PubMed  Google Scholar 

  54. Schikowski, T., Sugiri, D., Ranft, U., et al.: Long-term air pollution exposure and living close to busy roads are associated with COPD in women. Respir. Res. 6, 152 (2005)

    Article  PubMed  PubMed Central  Google Scholar 

  55. Sunyer, J., Jarvis, D., Gotschi, T., et al.: Chronic bronchitis and urban air pollution in an international study. Occup. Environ. Med. 63(12), 836–843 (2006)

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Halonen, J.I., Lanki, T., Yli-Tuomi, T., et al.: Urban air pollution, and asthma and COPD hospital emergency room visits. Thorax 63(7), 635–641 (2008)

    Article  CAS  PubMed  Google Scholar 

  57. Benbrahim-Tallaa, L., Baan, R., Grosse, Y., et al.: Carcinogenicity of diesel-engine and gasoline-engine exhausts and some nitroarenes. Lancet Oncol. 13(7), 663–664 (2012)

    Article  PubMed  Google Scholar 

  58. Loomis, D., Grosse, Y., Lauby-Secretan, B., et al.: The carcinogenicity of outdoor air pollution. Lancet Oncol. 14(13), 1262–1263 (2013)

    Article  CAS  PubMed  Google Scholar 

  59. Leksell, I., Rabl, A.: Air pollution and mortality: quantification and valuation of years of life lost. Risk Anal. 21, 843–857 (2001)

    Article  CAS  PubMed  Google Scholar 

  60. Miller, B., Hurley, F.: Comparing estimated risks for air pollution with risks for other health effects. IOM Research Report TM/06/01, March, 42 p. (2006)

  61. Röösli, M., Künzli, N., Braun-Fahrländer, C., Egger, M.: Years of life lost attributable to air pollution in Switzerland: dynamic exposure–response model. Int. J. Epidem. 34, 1029–1035 (2005)

    Article  Google Scholar 

  62. Chanel, O., Scapecchi, P., Vergnaud, J.-C.: How to correctly assess mortality benefits in public policies. J. Environ. Planing Manag. 49(5), 759–776 (2006)

    Article  Google Scholar 

  63. Crouse, D.L., Ross, N.A., Goldberg, M.S.: Double burden of deprivation and high concentrations of ambient air pollution at the neighbourhood scale in Montreal, Canada. Soc. Sci. Med. 69(6), 971–981 (2009)

    Article  PubMed  Google Scholar 

  64. Jephcote, C., Chen, H.: Geospatial analysis of naturally occurring boundaries in road-transport emissions and children’s respiratory health across a demographically diverse cityscape. Soc. Sci. Med. 82, 87–99 (2013)

    Article  PubMed  Google Scholar 

  65. Jerrett, M., Buzzelli, M., Burnett, R.T., DeLuca, P.F.: Particulate air pollution, social confounders, and mortality in small areas of an industrial city. Soc. Sci. Med. 60(12), 2845–2863 (2005)

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank Christophe Declercq, Alistair Hunt, Tek-Ang Lim, and Brian Miller for helpful comments and suggestions, and Marjorie Sweetko for her thorough re-reading of the English. The huge amount of work behind the Aphekom project is the fruit of the generous and constructive input from all the members of the Aphekom network, and we extend our special thanks and appreciation to all of them. The Aphekom project was co-funded by the European Commission’s Programme on community Action in the Field of Public Health (2003–2008) under Grant Agreement No. 2007105, and by the many national and local institutions that dedicated resources to accomplishing this project.

Funding

The Aphekom project was co-funded by the European Commission’s Programme on community Action in the Field of Public Health (2003–2008) under Grant Agreement No. 2007105, and by the many national and local institutions that dedicated resources to accomplishing this project. The funding sources had no role in the writing of the manuscript or in the decision to submit it for publication.

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Authors and Affiliations

  1. Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS, Greqam, 2 rue de la Charité, 13236, Marseille Cedex 02, France

    Olivier Chanel

  2. Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland

    Laura Perez & Nino Künzli

  3. University of Basel, Basel, Switzerland

    Laura Perez & Nino Künzli

  4. Département Santé Environnement, Institut de Veille Sanitaire, 12 rue du Val d’Osne, 94415, Saint Maurice Cedex, France

    Sylvia Medina

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  1. Olivier Chanel
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  2. Laura Perez
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  3. Nino Künzli
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  4. Sylvia Medina
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Aphekom group

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Correspondence to Olivier Chanel.

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On behalf of the Aphekom group.

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Chanel, O., Perez, L., Künzli, N. et al. The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project. Eur J Health Econ 17, 1101–1115 (2016). https://doi.org/10.1007/s10198-015-0748-z

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  • DOI: https://doi.org/10.1007/s10198-015-0748-z

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