The Impact of Temperature and Pollution on Mortality, Morbidity, and Health Care Cost Among the Elderly

其他项目信息-项目摘要/摘要 天气和污染对死亡率、发病率和医疗费用的影响 每年，医疗保险计划花费约5000亿美元为 老年人。医疗保健支出的增长给医疗保险信托基金带来了越来越大的压力，以及 对未来医疗保健需求和支出的准确预测对于正确规划未来是必要的 老龄化人口的需求。气候变化影响天气和污染的前景使这些 链接更具政策相关性。 以前关于环境对健康影响的研究主要集中在死亡率和住院方面。 招生。其他重要结果，如幸存者的身心健康和医疗费用 在极端事件之后的医疗利用一直受到限制，主要是因为缺乏适当的数据。这 该项目将记录温度和污染对美国老年人健康和医疗保健使用的影响。 通过首次将来自联邦医疗保险索赔的个人级别的医疗历史与 1992年至2011年的温度和污染数据。这些数据允许识别哪些组 特别容易受到环境冲击和量化医疗使用成本的影响 温度或污染的变化，这是气候变化的代价，以前从未测量过。我们会 记录个人适应当地普遍情况(如高温或污染)的程度，以缓解 环境冲击的影响。将医疗保险和环境数据与人口数据和 住房特点，我们将调查收入和住房特点，如空调 修改环境与健康的关系。我们还将利用两个新的准- 污染的实验变化--野火产生的烟雾和当地风况的变化--有助于 克服观察性研究的局限性，使我们能够估计污染对 健康和成本结果。 具体地说，该项目将追求四个目标：(1)就以下问题提供大规模和全面的证据 温度/污染与死亡率、发病率和医疗保险费用之间的因果关系；(2)确定 哪些老年亚群(例如，穷人、高龄、残疾或慢性病患者)是 最容易受到极端事件的影响，并衡量在极端事件中损失的生命年数，而不是 只计算原始死亡率；(3)调查适应在改变环境-健康关系中的作用； 以及(4)估计气候变化对老年人健康和医疗保险支出的影响。本研究 我将通过汇编一个新的数据集来实现这些目标，该数据集包含20年的每日温度和污染 个人居住邮政编码中的水平与个人层面的健康、医疗保健的详细衡量标准有关 使用情况，以及人口普查和其他来源的医疗费用和人口数据。

OTHER PROJECT INFORMATION – Project Summary/Abstract The Impact of Weather and Pollution on Mortality, Morbidity, and Health Care Cost Each year, the Medicare program spends around half a trillion dollars on providing healthcare for the elderly. Growth in health care expenditure is placing growing pressure on the Medicare Trust Fund, and accurate projections of future health care needs and spending are necessary to properly plan for the future needs of the aging population. The prospect of climate change affecting weather and pollution makes these links even more policy-relevant. Previous studies of environmental impacts on health have largely focused on mortality and hospital admissions. Other important outcomes, such as the physical and mental health of survivors and the cost of medical utilization following extreme events, have been limited, primarily due to a lack of appropriate data. This project will document the impact of temperature and pollution on elder health and health care use in the U.S. by linking, for the first time, individual-level medical treatment histories derived from Medicare claims with temperature and pollution data for the years 1992 through 2011. These data permit identifying which groups are particularly vulnerable to environmental shocks and quantifying the cost of medical utilization in response to temperature or pollution changes, a cost of climate change that has been previously unmeasured. We will document the extent to which individuals adapt to prevailing local conditions (e.g., heat or pollution), mitigating the impact of environmental shocks. Linking the Medicare and environmental data to demographic data and housing characteristics, we will investigate how income and housing characteristics such as air conditioning modify the relationship between environment and health. We will also make use of two new sources of quasi- experimental variation in pollution—smoke from wildfires and variation in local wind conditions—that help overcome the limitations of observational studies and allow us to estimate the causal impact of pollution on health and cost outcomes. Specifically, this project will pursue four goals: (1) Produce large-scale and comprehensive evidence on the causal relationship between temperature/pollution and mortality, morbidity, and Medicare costs; (2) Identify which elderly subpopulations (e.g., the poor, very aged or those living with disabilities or chronic illness) are the most vulnerable to extreme events and measure the number of life-years lost in an extreme event rather than just raw mortality counts; (3) Investigate the role of adaptation in modifying the environment-health relationship; and (4) Estimate the impact that climate change will have on elderly health and Medicare spending. This study will achieve these goals by compiling a novel dataset with two decades of daily temperature and pollution levels in an individual's zip code of residence linked to detailed measures of individual-level health, health care utilization, and medical costs and demographic data from the Census and other sources.