title: Non-linear increase of respiratory diseases and their costs under severe air pollution.
abstract: China is experiencing severe and persistent air pollution, with concentrations of fine particulate matters (PM2.5) reaching unprecedentedly high levels in many cities. Quantifying the detrimental effects on health and their costs derived from high PM2.5levels is crucial because of the unsolved challenges to mitigate air pollution in the following decades. Using the daily monitoring data on PM2.5concentrations and clinic visits, we found a non-linear increase of respiratory diseases, but not for other diseases (e.g., digestive diseases) under severe air pollution. We found an increase of respiratory diseases by 1% for each 10 μg m-3increase in PM2.5when the annual average daily PM2.5concentration was less than 50 μg m-3; while this ratio was doubled (around 2%) with the daily PM2.5concentration larger than 50 μg m-3. Under severe air pollution (PM2.5concentration >150 μg m-3), the respiratory diseases increased by over 50% compared to that in clean days. Children are more sensitive to the severe air pollution. The increase of clinic visits, especially for adults, was observed mainly in bigger (>500 beds) hospitals. Re-allocating medical resources (e.g., doctors) from big hospitals to community hospitals can benefit the respiratory patients due to air pollution. The total medical cost of clinic visits of respiratory diseases derived from PM2.5pollution was estimated at 17.2-57.0 billion Yuan in 2014 in China, accounting for 0.5-1.6% of national total health expenditure. Because these medical costs only represent a small part of total health cost derived from air pollution, the reduction of associated health costs would be an important co-benefit of implementation of air pollution preventive strategies.
authors.affiliation: Department of Neonatology, Children's Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, PR China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Shen
authors.affiliation: Policy Simulation Laboratory, Zhejiang University, Hangzhou 310058, PR China.
authors.forename: Yiyun
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Department of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, PR China.
authors.forename: Guangdi
authors.initials: G
authors.lastname: Chen
authors.affiliation: PBL Netherlands Environmental Assessment Agency, PO BOX 30314, 2500 GH The Hague, The Netherlands.
authors.forename: Hans J M
authors.initials: HJM
authors.lastname: Van Grinsven
authors.affiliation: Institute of Environmental Health, Zhejiang Center for Disease Control and Prevention, Hangzhou 310051, PR China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Wang
authors.affiliation: Policy Simulation Laboratory, Zhejiang University, Hangzhou 310058, PR China; Department of Land Management, Zhejiang University, Hangzhou 310058, PR China. Electronic address: bjgu@zju.edu.cn.
authors.forename: Baojing
authors.initials: B
authors.lastname: Gu
authors.affiliation: Institute of Environmental Health, Zhejiang Center for Disease Control and Prevention, Hangzhou 310051, PR China. Electronic address: xmlou@cdc.zj.cn.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Lou
mesh_terms: D000293:Adolescent; D000328:Adult; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D002947:Cities; D004787:Environmental Pollution / Q000009:adverse effects; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008171:Lung Diseases / Q000191:economics* / Q000453:epidemiology / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D052638:Particulate Matter / Q000009:adverse effects* / Q000032:analysis; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter
keywords: Age structure; China; Clinic visit; Health cost; Medical resource; PM(2.5)