title: Cost of near-roadway and regional air pollution-attributable childhood asthma in Los Angeles County.
abstract: BACKGROUND
  Emerging evidence suggests that near-roadway air pollution (NRP) exposure causes childhood asthma. The associated costs are not well documented.
  
  
  OBJECTIVE
  We estimated the cost of childhood asthma attributable to residential NRP exposure and regional ozone (O3) and nitrogen dioxide (NO2) levels in Los Angeles County. We developed a novel approach to apportion the costs between these exposures under different pollution scenarios.
  
  
  METHODS
  We integrated results from a study of willingness to pay to reduce the burden of asthma with results from studies of health care use and charges to estimate the costs of an asthma case and exacerbation. We applied those costs to the number of asthma cases and exacerbations caused by regional pollution in 2007 and to hypothetical scenarios of a 20% reduction in regional pollution in combination with a 20% reduction or increase in the proportion of the total population living within 75 m of a major roadway.
  
  
  RESULTS
  Cost of air pollution-related asthma in Los Angeles County in 2007 was $441 million for O3 and $202 million for NO2 in 2010 dollars. Cost of routine care (care in absence of exacerbation) accounted for 18% of the combined NRP and O3 cost and 39% of the combined NRP and NO2 cost; these costs were not recognized in previous analyses. NRP-attributable asthma accounted for 43% (O3) to 51% (NO2) of the total annual cost of exacerbations and routine care associated with pollution. Hypothetical scenarios showed that costs from increased NRP exposure might offset savings from reduced regional pollution.
  
  
  CONCLUSIONS
  Our model disaggregates the costs of regional pollution and NRP exposure and illustrates how they might vary under alternative exposure scenarios. The cost of air pollution is a substantial burden on families and an economic loss for society.
authors.affiliation: Center for Public Policy and Administration and the Department of Resource Economics, University of Massachusetts Amherst, Amherst, Mass. Electronic address: sylvbrandt@gmail.com.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Brandt
authors.affiliation: University of Basel, Basel, Switzerland; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Laura
authors.initials: L
authors.lastname: Perez
authors.affiliation: University of Basel, Basel, Switzerland; Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
authors.forename: Nino
authors.initials: N
authors.lastname: Künzli
authors.affiliation: Sonoma Technology, Petaluma, Calif.
authors.forename: Fred
authors.initials: F
authors.lastname: Lurmann
authors.affiliation: Spatial Science Institute, University of Southern California, Los Angeles, Calif.
authors.forename: John
authors.initials: J
authors.lastname: Wilson
authors.affiliation: Program for Environmental and Regional Equity, University of Southern California, Los Angeles, Calif.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pastor
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
authors.forename: Rob
authors.initials: R
authors.lastname: McConnell
mesh_terms: D000293:Adolescent; D000393:Air Pollutants / Q000009:adverse effects; D001249:Asthma / Q000139:chemically induced / Q000191:economics* / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003365:Costs and Cost Analysis; D005260:Female; D006801:Humans; D008297:Male; D009585:Nitrogen Dioxide / Q000009:adverse effects / Q000191:economics*; D010083:Oxidants, Photochemical / Q000009:adverse effects / Q000191:economics*; D010126:Ozone / Q000009:adverse effects / Q000191:economics*; D001335:Vehicle Emissions / Q000633:toxicity*
chemical_list: D000393:Air Pollutants; D010083:Oxidants, Photochemical; D001335:Vehicle Emissions; D010126:Ozone; D009585:Nitrogen Dioxide
keywords: Air pollution; asthma; cost of illness; urban growth; vehicle emissions; willingness to pay