Research Article: Estimating the costs of air pollution to the National Health Service and social care: An assessment and forecast up to 2035

Date Published: July 10, 2018

Publisher: Public Library of Science

Author(s): Laura Pimpin, Lise Retat, Daniela Fecht, Laure de Preux, Franco Sassi, John Gulliver, Annalisa Belloni, Brian Ferguson, Emily Corbould, Abbygail Jaccard, Laura Webber, Aziz Sheikh

Abstract: BackgroundAir pollution damages health by promoting the onset of some non-communicable diseases (NCDs), putting additional strain on the National Health Service (NHS) and social care. This study quantifies the total health and related NHS and social care cost burden due to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) in England.Method and findingsAir pollutant concentration surfaces from land use regression models and cost data from hospital admissions data and a literature review were fed into a microsimulation model, that was run from 2015 to 2035. Different scenarios were modelled: (1) baseline ‘no change’ scenario; (2) individuals’ pollutant exposure is reduced to natural (non-anthropogenic) levels to compute the disease cases attributable to PM2.5 and NO2; (3) PM2.5 and NO2 concentrations reduced by 1 μg/m3; and (4) NO2 annual European Union limit values reached (40 μg/m3). For the 18 years after baseline, the total cumulative cost to the NHS and social care is estimated at £5.37 billion for PM2.5 and NO2 combined, rising to £18.57 billion when costs for diseases for which there is less robust evidence are included. These costs are due to the cumulative incidence of air-pollution-related NCDs, such as 348,878 coronary heart disease cases estimated to be attributable to PM2.5 and 573,363 diabetes cases estimated to be attributable to NO2 by 2035. Findings from modelling studies are limited by the conceptual model, assumptions, and the availability and quality of input data.ConclusionsApproximately 2.5 million cases of NCDs attributable to air pollution are predicted by 2035 if PM2.5 and NO2 stay at current levels, making air pollution an important public health priority. In future work, the modelling framework should be updated to include multi-pollutant exposure–response functions, as well as to disaggregate results by socioeconomic status.

Partial Text: Air pollution is a major public health concern with a high burden of disease. Exposure to fine particulate matter (PM2.5) and nitrogen dioxide (NO2) increases the risk of non-communicable diseases (NCDs) such as cardiovascular disease, respiratory disease, and lung cancer [1–3], as well as exacerbating existing conditions such as asthma and chronic obstructive pulmonary disease (COPD). These chronic conditions are expensive to treat and put unnecessary strain on an already overworked healthcare system. Little is known about the extent of the attributable cost of these diseases to air pollution, now and into the future. Understanding the extent and magnitude of air pollution’s impact on long-term health is important for future National Health Service (NHS) budget allocation, priority setting, and policy planning.

In England, in 2017, PM2.5 was estimated to cost the NHS and social care £76.10 million and NO2 was estimated to cost £81.06 million. These estimated costs are the result of 63,430 attributable incident cases of PM2.5-related diseases and 60,648 attributable incident cases of NO2-related diseases occurring in 2017. This accounts for around 10% of the total burden of diseases related to PM2.5 and around 9% of the total burden of diseases related to NO2 in 2017. Between 2017 and 2025, the total cost to the NHS and social care of air pollution in England was estimated to be £1.54 billion for PM2.5 and £60.81 million for NO2, increasing to £2.81 billion and £2.75 billion, respectively, when all diseases associated with these pollutants are included (strong and weaker evidence combined). Secondary care was estimated to contribute most to PM2.5-related costs, and social care to contribute most to NO2-related costs. This latter finding is due to the inclusion of dementia as a disease related to NO2 (but not PM2.5), which has a very high social care cost burden. We estimated that reducing each pollutant by 1 μg/m3 in 1 year alone would have important long-term impacts on health. Avoiding disease cases is necessary if disease burden from air pollution is to be reduced.



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