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

Abstract

Background Emerging evidence suggests that near-roadway air pollution (NRP) exposure causes childhood asthma. 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) 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 studies of health care utilization and charges to estimate the costs of an asthma case and exacerbation. We applied those costs to the number of asthma cases and exacerbations due to 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 75m 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—costs 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 may 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.

Electronic Cigarette Use and Respiratory Symptoms in Adolescents

“…Bronchitis or questionnaire-based report of persistent cough and phlegm are relatively imprecise outcomes and likely represent a heterogeneous complex of conditions, including chronic, indolent respiratory illness, asthma exacerbation, or chronic airway inflammation. These outcomes might also reflect repeated acute exacerbations, including acute bronchitis that has been reported to persist for several weeks and to have a marked impact on quality of life, in adults and in children (14,27). Bronchitis and bronchitic symptoms have shown robust associations with diverse respiratory hazards in previous epidemiologic studies (15,(17)(18)(19), including with childhood smoking and exposure to SHS (17,18).…”

“…Bronchitis and chronic bronchitic symptoms are common and have been associated with substantial clinical morbidity and economic cost (14,(24)(25)(26). Bronchitis or questionnaire-based report of persistent cough and phlegm are relatively imprecise outcomes and likely represent a heterogeneous complex of conditions, including chronic, indolent respiratory illness, asthma exacerbation, or chronic airway inflammation.…”

“…We evaluated the associations of e-cigarette use with wheeze and chronic bronchitic symptoms, which are both common and account for substantial morbidity in children (14). These symptoms have been shown in the CHS and other studies to be associated with smoking and exposure to secondhand tobacco smoke (SHS), ambient air pollution, and other respiratory irritants (14)(15)(16)(17)(18)(19). The results of this study were reported at the Society for Research on Nicotine and Tobacco (Philadelphia, Pennsylvania, February 27, 2015).…”

Association of Changes in Air Quality With Bronchitic Symptoms in Children in California, 1993-2012

“…[1–8] Several studies indicate that exposure to elevated concentrations of ambient air pollution, often at levels below regulatory standards, is associated with large increases in the prevalence of bronchitic symptoms among children with asthma, [1, 5, 9, 10] potentially resulting in a heavy burden of disease in exposed children with substantial economic cost. [11, 12]…”

Risk effects of near-roadway pollutants and asthma status on bronchitic symptoms in children

“…1,2 Several studies have now shown positive associations between regional air pollutants and prevalence of bronchitic symptoms in children. 3–8 Moreover, recent findings from the southern California Children’s Health Study (CHS) suggested that reductions in ambient pollution levels across several cohorts of children were associated with lower prevalence of bronchitic symptoms, further implicating the importance of air pollution in the etiology of this outcome.…”