title: The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project.
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 PM10and 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.
authors.affiliation: Aix-Marseille University (Aix-Marseille School of Economics), CNRS & EHESS, Greqam, 2 rue de la Charité, 13236, Marseille Cedex 02, France. olivier.chanel@univ-amu.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Chanel
authors.affiliation: Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Laura
authors.initials: L
authors.lastname: Perez
authors.affiliation: Swiss Tropical and Public Health Institute, Socinstrasse 57, 4002, Basel, Switzerland.|University of Basel, Basel, Switzerland.
authors.forename: Nino
authors.initials: N
authors.lastname: Künzli
authors.affiliation: Département Santé Environnement, Institut de Veille Sanitaire, 12 rue du Val d'Osne, 94415, Saint Maurice Cedex, France.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Medina
mesh_terms: D000293:Adolescent; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects; D000397:Air Pollution / Q000009:adverse effects*; D001249:Asthma / Q000191:economics* / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003327:Coronary Disease / Q000191:economics* / Q000453:epidemiology* / Q000209:etiology; D017281:Cost of Illness; D004781:Environmental Exposure / Q000009:adverse effects*; D005060:Europe / Q000453:epidemiology; D005260:Female; D062489:Health Impact Assessment; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007223:Infant; D008297:Male; D009017:Morbidity; D018986:Motor Vehicles; D011788:Quality of Life; D014505:Urban Population
chemical_list: D000393:Air Pollutants
keywords: Air pollution; Economic assessment; Europe; Health effects; Local traffic-related exposure