Attributable Risk and Economic Cost of Cardiovascular Hospital Admissions Due to Ambient Particulate Matter in Wuhan, China

Abstract

Although the adverse effects of ambient particulate matter (PM) on cardiovascular disease (CVD) have been previously documented, information about their economic consequence was insufficient. This study aimed to evaluate the attributable risk and economic cost of cardiovascular hospitalizations due to ambient PM. Data of CVD hospitalizations and PM concentrations from 1 January 2015 to 31 December 2017 were collected in Wuhan, China. A generalized additive model was applied to quantify the PM-attributable CVD hospitalizations, and total attributable hospitalization costs were calculated via multiplying the total attributable cases by the case-average hospitalization costs. A total of 45,714 CVD hospitalizations were included in this study. The results showed that a 10 µg/m³ increase in PM_2.5 and PM₁₀ concentrations at lag7 day, respectively, contributed to a 1.01% (95% confidence interval: 0.67-1.34) and 0.48% (0.26-0.70) increase in CVD hospitalizations. During the study period, 1487 and 983 CVD hospitalizations were attributable to PM_2.5 and PM₁₀, equaling an economic cost of 29.27 and 19.34 million RMB (1 RMB = 0.1424 USD), respectively, and significant differences in PM-attributable hospitalizations and economic burden were found between gender and age groups. Our study added evidence in heavily polluted megacities regarding the increased health risk and economic cost of CVD hospitalizations associated with ambient particulate pollution.

Keywords: ambient particulate matter; attributable hospitalization costs; cardiovascular disease; hospitalizations.

Figure 1

The decomposed distributions for the daily concentrations of PM_2.5 and PM₁₀, daily hospitalizations and case-average hospitalization costs due to CVD in Wuhan, China, from 2015–2017. (A) daily concentration of PM_2.5; (B) daily concentration of PM₁₀; (C) daily number of hospitalizations; (D) case-average hospitalization costs.

Figure 2

The estimated percent change of cardiovascular disease (CVD) hospitalizations due to a 10 µg/m³ increase in PM_2.5 and PM₁₀ concentrations.

Figure 3

The estimated percent change of CVD hospitalizations per 10 µg/m³ increase in PM_2.5 and PM₁₀ concentrations, by gender and age group. PC: percent change; CI: confidence interval.

Figure 4

The estimated annual avoidable hospitalizations and savable hospitalization costs if the historical concentrations of PM_2.5 and PM₁₀ could be maintained at relatively low levels. The air quality standard proposed by the WHO (24-h average value: 25 µg/m³ for PM_2.5 and 50 µg/m³ for PM₁₀) was considered as the reference.