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Degrees and dollars - Health costs associated with suboptimal ambient temperature exposure.

ABSTRACT: Suboptimal ambient temperature exposure significantly affects public health. Previous studies have primarily focused on risk assessment, with few examining the health outcomes from an economic perspective. To inform environmental health policies, we estimated the economic costs of health outcomes associated with suboptimal temperature in the Minneapolis/St. Paul Twin Cities Metropolitan Area. We used a distributed lag nonlinear model to estimate attributable fractions/cases for mortality, emergency department visits, and emergency hospitalizations at various suboptimal temperature levels. The analyses were stratified by age group (i.e., youth (0-19 years), adult (20-64 years), and senior (65+ years)). We considered both direct medical costs and loss of productivity during economic cost assessment. Results show that youth have a large number of temperature-related emergency department visits, while seniors have large numbers of temperature-related mortality and emergency hospitalizations. Exposures to extremely low and high temperatures lead to $2.70 billion [95% empirical confidence interval (eCI): $1.91 billion, $3.48 billion] (costs are all based on 2016 USD value) economic costs annually. Moderately and extremely low and high temperature leads to $9.40 billion [eCI: $6.05 billion, $12.57 billion] economic costs. The majority of the economic costs are consistently attributed to cold (>75%), rather than heat exposures and to mortality (>95%), rather than morbidity. Our findings support prioritizing temperature-related health interventions designed to minimize the economic costs by targeting seniors and to reduce attributable cases by targeting youth.

SUBMITTER: Liu Y

PROVIDER: S-EPMC10184024 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Degrees and dollars - Health costs associated with suboptimal ambient temperature exposure.

Liu Yang Y Saha Shubhayu S Hoppe Brendalynn O BO Convertino Matteo M

The Science of the total environment 20190429

Suboptimal ambient temperature exposure significantly affects public health. Previous studies have primarily focused on risk assessment, with few examining the health outcomes from an economic perspective. To inform environmental health policies, we estimated the economic costs of health outcomes associated with suboptimal temperature in the Minneapolis/St. Paul Twin Cities Metropolitan Area. We used a distributed lag nonlinear model to estimate attributable fractions/cases for mortality, emerge ...[more]

PMID: 31078861

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Project description:ImportanceCardiovascular disease (CVD) is the leading cause of death and disability among women. Achievement of recommended physical activity (PA) levels is an essential component of CVD management.ObjectiveTo describe trends, sociodemographic factors, and health care expenditures associated with suboptimal PA among a nationally representative sample of US women with CVD.Design, setting, and participantsThis cross-sectional study used serial data from the Medical Expenditure Panel Survey from 2006 through 2015. The analyses were conducted in August 2018. Women who had self-reported and/or International Classification of Diseases, Ninth Revision, diagnosis of CVD were included.Main outcomes and measuresRecommended PA was defined as 30 minutes or more of moderate- to vigorous-intensity exercise, 5 or more days per week. Weighted logistic regression was used to examine the associations of various sociodemographic factors with suboptimal PA, adjusted for comorbidities. A 2-part econometric model was used to assess health care expenditures.ResultsA total of 18 027 women were included in this study. The results were weighted to provide estimates for approximately 19.5 million adult women in the United States with CVD (mean [SD] age, 60.4 [16.9] years). More than half of the women with CVD reported suboptimal PA, a trend that increased during the 10-year period, with 58.2% (95% CI, 55.9%-60.5%) of participants reporting suboptimal PA in 2006-2007 vs 61.9% (95% CI, 59.7%-64.2%) in 2014-2015 (P = .004). The proportion of women with suboptimal PA differed by sociodemographic factors. In adjusted models, compared with non-Hispanic white women, African American women (odds ratio, 1.22; 95% CI, 1.08-1.38) and Hispanic women (odds ratio, 1.33; 95% CI, 1.13-1.58) were more likely to have suboptimal PA. Women from low- or very low-income strata (compared with high-income strata), enrolled in public insurance (compared with private insurance), and with less than high school education (compared with at least some college education) were more likely to have suboptimal PA. Health care costs among women with CVD with suboptimal PA were higher compared with those among women who met the recommended PA, and this increased through time, from a mean total health care expenditure of $12 724 (95% CI, $11 627-$13 821) in 2006-2007 to $14 820 (95% CI, $13 521-$16 119) in 2014-2015.Conclusions and relevanceThe proportion of women with CVD not meeting recommended PA is high and increasing, particularly among certain racial/ethnic and socioeconomic groups, and is associated with significant health care costs. More must be done to improve PA for secondary prevention and reduction of expenditures among women with CVD.

Project description:Background and objectivesAn understanding of the health care resource use associated with AKI is needed to frame the investment and cost-effectiveness of strategies to prevent AKI and promote kidney recovery.Design, setting, participants, & measurementsWe assembled population-based cohort of adults hospitalized in Alberta between November of 2002 and March of 2009 without ESRD or an eGFR<15 ml/min per 1.73 m2. Outpatient serum creatinine measurements 6 months preceding admission defined baseline kidney function, and serum creatinine during the first 14 days of hospitalization defined Acute Kidney Injury Network stage; kidney recovery defined as serum creatinine within 25% of baseline and independence from dialysis was assessed at 90 days after AKI. Health care utilization and costs (in 2015 Canadian dollars) were determined from inpatient, outpatient, and physician claims datasets during the index hospitalization, recovery period (90 days post-AKI assessment), and 3-12 months post-AKI. A fully adjusted generalized linear model regression analysis was used to estimate costs associated with AKI.ResultsOf 239,906 hospitalized subjects, 25,495 (10.6%), 4598 (1.9%), 2493 (1.0%), and 670 (0.3%) had Acute Kidney Injury Network stages 1, 2, 3 without dialysis, and 3 with dialysis, respectively. Greater severity of AKI was associated with incremental increases in length of stay (+2.8; 95% confidence interval, 1.4 to 4.3 to +7.4; 95% confidence interval, 7.2 to 7.5 days) and costs (+$3779; 95% confidence interval, $3555 to $4004 to +$18,291; 95% confidence interval, $15,573 to $21,009 Canadian dollars) from admission to recovery assessment (3 months). At months 3-12 postadmission, compared with subjects without AKI, AKI with kidney recovery and AKI without kidney recovery were associated with incremental costs of +$2912-$3231 and +$6035-$8563 Canadian dollars, respectively. The estimated incremental cost of AKI in Canada is estimated to be over $200 million Canadian dollars per year.ConclusionsSeverity of AKI, need for dialysis, and lack of kidney recovery are associated with significant health care costs in hospitalized patients and persist a year after admission. Strategies to identify, prevent, and facilitate kidney recovery are needed.

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Degrees and dollars - Health costs associated with suboptimal ambient temperature exposure.

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Degrees and dollars - Health costs associated with suboptimal ambient temperature exposure.

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