Kaiser Permanente study finds higher total health care costs for people with heart disease
By Sue Rochman
Long-term exposure to traffic-related air pollution is associated with higher health care costs for older adults, according to a new study by Kaiser Permanente researchers.
The study, published in Atmospheric Environment, was co-first authored by Stacey E. Alexeeff, PhD, a research scientist at the Division of Research, and Ananya Roy, ScD, a senior health scientist at the Environmental Defense Fund (EDF).
“Originally, scientists thought pollution only increased risk for lung problems, but then we realized it also affected the heart, and new research suggests that it increases risk for diabetes and can reduce cognitive function,” said Alexeeff. “Our study is important because it’s not looking at just one way pollution impacts our health, but all the reasons why exposure to air pollution might be tied to your overall health care costs, by affecting many different health conditions that could lead to more appointments and more visits to emergency rooms.”
The research team analyzed data from their previous joint block-by-block study of air pollution in Oakland, California, and 5 years of electronic health records of more than 25,000 members of Kaiser Permanente Northern California ages 65 and over.
The study linked air quality data, gathered from monitors affixed to Google Street View cars that repeatedly measured block-by-block air pollution concentrations, with residential addresses. To calculate comprehensive health care costs, researchers analyzed detailed records of annual total health care costs from inpatient, outpatient, and emergency room visits, and pharmacy costs.
The researchers found that even small differences in concentrations of nitrogen dioxide, a key traffic-related air pollutant, were associated with increased health care costs.
“Nearly 80% of the U.S. population lives in an urban area and our research adds to the evidence that air pollution in these areas has numerous recognized adverse health impacts as well as economic ones,” said senior author Stephen Van Den Eeden, PhD, a research scientist at the Division of Research. “We believe analyses like ours can help us to understand the full health and economic impacts of air pollution.”
Specifically, living in an area with concentrations of nitrogen dioxide that are 5.9 parts per billion higher than another area was associated with a 22% increase in emergency room costs and 5% increase in outpatient costs. Among residents with heart disease, higher air pollution was associated with 7% higher total annual direct health care costs and 23% higher emergency room costs compared to a similar population with lower pollution exposures.
“Street-level air quality data shines a light on pollution hotspots, enabling a better understanding of traffic-related air pollution’s impacts on health and associated costs within cities,” said EDF’s Roy. “We know reducing traffic-related air pollution presents an opportunity to protect public health. This new research suggests it could also help substantially reduce health care costs.”
This study was funded by the Environmental Defense Fund.
Co-authors include Jun Shan, PhD, G. Thomas Ray, MBA, and Charles P. Quesenberry, PhD, of the Division of Research; Joshua Apte, PhD, of the University of California, Berkeley; and Christopher J. Portier, PhD, of the Environmental Defense Fund.
Read the Environmental Defense Fund’s release here.