Cost of near-roadway and regional air pollution–attributable childhood asthma in Los Angeles County

• Published in: Journal of allergy and clinical immunology 2014-11, Vol.134 (5), p.1028-1035
• Main Authors: Brandt, Sylvia, PhD, Perez, Laura, PhD, Künzli, Nino, MD, PhD, Lurmann, Fred, MS, Wilson, John, PhD, Pastor, Manuel, PhD, McConnell, Rob, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Air Pollutants - adverse effects; Air pollution; Airborne particulates; Allergy and Immunology; Asthma; Asthma - chemically induced; Asthma - economics; Asthma - epidemiology; Biological and medical sciences; California - epidemiology; Child; Child, Preschool; Children & youth; Chronic obstructive pulmonary disease, asthma; Cost control; cost of illness; Costs and Cost Analysis; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Male; Medical sciences; Nitrogen dioxide; Nitrogen Dioxide - adverse effects; Nitrogen Dioxide - economics; Outdoor air quality; Oxidants, Photochemical - adverse effects; Oxidants, Photochemical - economics; Ozone - adverse effects; Ozone - economics; Pneumology; Pollutants; Population; Risk assessment; Roads & highways; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; urban growth; vehicle emissions; Vehicle Emissions - toxicity; willingness to pay
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2014.09.029

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.