Particulate Matter Exposure and Preterm Birth: Estimates of U.S. Attributable Burden and Economic Costs

Abstract

Background:Preterm birth (PTB) rates (11.4% in 2013) in the United States remain high and are a substantial cause of morbidity. Studies of prenatal exposure have associated particulate matter ≤ 2.5 μm in diameter (PM2.5) and other ambient air pollutants with adverse birth outcomes; yet, to our knowledge, burden and costs of PM2.5-attributable PTB have not been estimated in the United States.Objectives:We aimed to estimate burden of PTB in the United States and economic costs attributable to PM2.5 exposure in 2010.Methods:Annual deciles of PM2.5 were obtained from the U.S. Environmental Protection Agency. We converted PTB odds ratio (OR), identified in a previous meta-analysis (1.15 per 10 μg/m3 for our base case, 1.07–1.16 for low- and high-end scenarios) to relative risk (RRs), to obtain an estimate that better represents the true relative risk. A reference level (RL) of 8.8 μg/m3 was applied. We then used the RR estimates and county-level PTB prevalence to quantify PM2.5-attributable PTB. Direct medical costs were obtained from the 2007 Institute of Medicine report, and lost economic productivity (LEP) was estimated using a meta-analysis of PTB-associated IQ loss, and well-established relationships of IQ loss with LEP. All costs were calculated using 2010 dollars.Results:An estimated 3.32% of PTBs nationally (corresponding to 15,808 PTBs) in 2010 could be attributed to PM2.5 (PM2.5 > 8.8 μg/m3). Attributable PTBs cost were estimated at $5.09 billion [sensitivity analysis (SA): $2.43–9.66 B], of which $760 million were spent for medical care (SA: $362 M–1.44 B). The estimated PM2.5 attributable fraction (AF) of PTB was highest in urban counties, with highest AFs in the Ohio Valley and the southern United States.Conclusions:PM2.5 may contribute substantially to burden and costs of PTB in the United States, and considerable health and economic benefits could be achieved through environmental regulatory interventions that reduce PM2.5 exposure in pregnancy.Citation:Trasande L, Malecha P, Attina TM. 2016. Particulate matter exposure and preterm birth: estimates of U.S. attributable burden and economic costs. Environ Health Perspect 124:1913–1918; http://dx.doi.org/10.1289/ehp.1510810

Air Quality, Health and Community Action

“…Ozone appears to increase the risk of early delivery, but it decreases the risk of term low birth weight [33]. The estimated annual cost of preterm births associated with air pollution in the United States has been estimated to be about $5 billion with an estimated 3.32 % of the preterm births attributed to PM2.5 being greater than 8.8 micrograms per cubic meter [77]. Sulfur dioxide contributed to low birth weight babies in China [91].…”

The mutual influences of man-made pollutants and allergic manifestations

“…It has been shown that in 2010, around 15,808 preterm births within the USA could be attributed to PM2.5 exposure. The concomitant preterm birth cost was estimated at 4 billion USD, of which 760 million USD were spent on medical care (Trasande, Malecha et al, 2016). Another study in South Carolina estimated the incremental costs of comorbidities observed in preterm infants to range from 4.529 to 23.121 USD.…”

Overview of the Model and Observation Evaluation Toolkit (MONET) Version 1.0 for Evaluating Atmospheric Transport Models

“…Trasande et al [3] found the cost of medical care for preterm births attributable to PM 2.5 exposure to be between $2.43 and $9.66 billion. Ghude et al [4] demonstrates the economic cost of poor air quality in India to crop yields is estimated to be around $1.26 billion annually.…”