The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project
The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project
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DOI：
10.1007/s10198-015-0748-z
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发表时间：
2016-12-01
影响因子：
4.4
通讯作者：
Medina, Sylvia
中科院分区：
文献类型：
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作者：
Chanel, Olivier;Perez, Laura;Medina, Sylvia
公共决策者通常使用健康影响评估（HIA）来量化各种监管政策的影响。然而，标准HIA并不认为慢性病（CD）可以由共同因素引起和加剧，并且通常侧重于病情恶化。例如，暴露于近道路交通相关污染（NRTP）可能会影响CD的发作，一般环境或城市背景空气污染（BP）可能会加剧这些CD。我们提出了一个全面的HIA，明确说明了急性影响和长期影响，使人们有可能计算归因于空气污染的疾病的总体负担。一项案例研究将两种HIA方法应用于两种CD-儿童哮喘和65岁以上成人冠心病（CHD）-10个欧洲城市，共计189万0-17岁儿童和185万65岁及以上成人。我们将目前的健康影响与假设的健康影响进行了比较，假设居住在忙碌繁忙道路附近的人与居住在较远道路附近的人接触NRTP的程度相同，并且如果PM10和NO2的年平均浓度（作为一般城市空气污染的标志）不高于20 μ g/m3。退还摊款55万美元（95%CI 0-0.95），仅基于急性效应的HIA仅占综合方法计算的年住院负担的6.2%[（原文如此）881万（95%CI 3-14.4）]，约占空气污染相关CD总体经济负担的0.15%[（原文如此）3.7亿（95%CI 106-592）]。因此，发病效应对卫生系统的影响比以前认为的更直接和更强烈。这些研究结果可能会澄清任何公共卫生或环境政策的好处，涉及由于共同因素和共同因素加剧的CD。
Public decision-makers commonly use health impact assessments (HIA) to quantify the impacts of various regulation policies. However, standard HIAs do not consider that chronic diseases (CDs) can be both caused and exacerbated by a common factor, and generally focus on exacerbations. As an illustration, exposure to near road traffic-related pollution (NRTP) may affect the onset of CDs, and general ambient or urban background air pollution (BP) may exacerbate these CDs. We propose a comprehensive HIA that explicitly accounts for both the acute effects and the long-term effects, making it possible to compute the overall burden of disease attributable to air pollution. A case study applies the two HIA methods to two CDs-asthma in children and coronary heart disease (CHD) in adults over 65-for ten European cities, totaling 1.89 million 0-17-year-old children and 1.85 million adults aged 65 and over. We compare the current health effects with those that might, hypothetically, be obtained if exposure to NRTP was equally low for those living close to busy roads as it is for those living farther away, and if annual mean concentrations of both PM10 and NO2-taken as markers of general urban air pollution-were no higher than 20 mu g/m(3). Returning an assessment of (sic) 0.55 million (95 % CI 0-0.95), the HIA based on acute effects alone accounts for only about 6.2 % of the annual hospitalization burden computed with the comprehensive method [(sic) 8.81 million (95 % CI 3-14.4)], and for about 0.15 % of the overall economic burden of air pollution-related CDs [(sic) 370 million (95 % CI 106-592)]. Morbidity effects thus impact the health system more directly and strongly than previously believed. These findings may clarify the full extent of benefits from any public health or environmental policy involving CDs due to and exacerbated by a common factor.