Dataset Information

Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study.

ABSTRACT: Objective: To assess risks and costs of hospital admission associated with short term exposure to fine particulate matter with diameter less than 2.5 µm (PM_2.5) for 214 mutually exclusive disease groups.

Design: Time stratified, case crossover analyses with conditional logistic regressions adjusted for non-linear confounding effects of meteorological variables.

Setting: Medicare inpatient hospital claims in the United States, 2000-12 (n=95?277?169).

Participants: All Medicare fee-for-service beneficiaries aged 65 or older admitted to hospital.

Main outcome measures: Risk of hospital admission, number of admissions, days in hospital, inpatient and post-acute care costs, and value of statistical life (that is, the economic value used to measure the cost of avoiding a death) due to the lives lost at discharge for 214 disease groups.

Results: Positive associations between short term exposure to PM_2.5 and risk of hospital admission were found for several prevalent but rarely studied diseases, such as septicemia, fluid and electrolyte disorders, and acute and unspecified renal failure. Positive associations were also found between risk of hospital admission and cardiovascular and respiratory diseases, Parkinson's disease, diabetes, phlebitis, thrombophlebitis, and thromboembolism, confirming previously published results. These associations remained consistent when restricted to days with a daily PM_2.5 concentration below the WHO air quality guideline for the 24 hour average exposure to PM_2.5. For the rarely studied diseases, each 1 µg/m³ increase in short term PM_2.5 was associated with an annual increase of 2050 hospital admissions (95% confidence interval 1914 to 2187 admissions), 12?216 days in hospital (11?358 to 13?075), US$31m (£24m, €28m; $29m to $34m) in inpatient and post-acute care costs, and $2.5bn ($2.0bn to $2.9bn) in value of statistical life. For diseases with a previously known association, each 1 µg/m³ increase in short term exposure to PM_2.5 was associated with an annual increase of 3642 hospital admissions (3434 to 3851), 20?098 days in hospital (18?950 to 21?247), $69m ($65m to $73m) in inpatient and post-acute care costs, and $4.1bn ($3.5bn to $4.7bn) in value of statistical life.

Conclusions: New causes and previously identified causes of hospital admission associated with short term exposure to PM_2.5 were found. These associations remained even at a daily PM_2.5 concentration below the WHO 24 hour guideline. Substantial economic costs were linked to a small increase in short term PM_2.5.

SUBMITTER: Wei Y

PROVIDER: S-EPMC6880251 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Publications

Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study.

Wei Yaguang Y Wang Yan Y Di Qian Q Choirat Christine C Wang Yun Y Koutrakis Petros P Zanobetti Antonella A Dominici Francesca F Schwartz Joel D JD

BMJ (Clinical research ed.) 20191127

<h4>Objective</h4>To assess risks and costs of hospital admission associated with short term exposure to fine particulate matter with diameter less than 2.5 µm (PM<sub>2.5</sub>) for 214 mutually exclusive disease groups.<h4>Design</h4>Time stratified, case crossover analyses with conditional logistic regressions adjusted for non-linear confounding effects of meteorological variables.<h4>Setting</h4>Medicare inpatient hospital claims in the United States, 2000-12 (n=95 277 169).<h4>Participants< ...[more]

PMID: 31776122

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Project description:ImportanceThe association between short-term exposure to air pollution and mortality has been widely documented worldwide; however, few studies have applied causal modeling approaches to account for unmeasured confounders that vary across time and space.ObjectiveTo estimate the association between short-term changes in fine particulate matter (PM2.5) and nitrogen dioxide (NO2) concentrations and changes in daily all-cause mortality rates using a causal modeling approach.Design, setting, and participantsThis cross-sectional study used air pollution and mortality data from Jiangsu, China; California; central-southern Italy; and Germany with interactive fixed-effects models to control for both measured and unmeasured spatiotemporal confounders. A total of 8 963 352 deaths in these 4 regions from January 1, 2015, to December 31, 2019, were included in the study. Data were analyzed from June 1, 2021, to October 30, 2023.ExposureDay-to-day changes in county- or municipality-level mean PM2.5 and NO2 concentrations.Main outcomes and measuresDay-to-day changes in county- or municipality-level all-cause mortality rates.ResultsAmong the 8 963 352 deaths in the 4 study regions, a 10-μg/m3 increase in daily PM2.5 concentration was associated with an increase in daily all-cause deaths per 100 000 people of 0.01 (95% CI, 0.001-0.01) in Jiangsu, 0.03 (95% CI, 0.004-0.05) in California, 0.10 (95% CI, 0.07-0.14) in central-southern Italy, and 0.04 (95% CI, 0.02- 0.05) in Germany. The corresponding increases in mortality rates for a 10-μg/m3 increase in NO2 concentration were 0.04 (95% CI, 0.03-0.05) in Jiangsu, 0.03 (95% CI, 0.01-0.04) in California, 0.10 (95% CI, 0.05-0.15) in central-southern Italy, and 0.05 (95% CI, 0.04-0.06) in Germany. Significant effect modifications by age were observed in all regions, by sex in Germany (eg, 0.05 [95% CI, 0.03-0.06] for females in the single-pollutant model of PM2.5), and by urbanicity in Jiangsu (0.07 [95% CI, 0.04-0.10] for rural counties in the 2-pollutant model of NO2).Conclusions and relevanceThe findings of this cross-sectional study contribute to the growing body of evidence that increases in short-term exposures to PM2.5 and NO2 may be associated with increases in all-cause mortality rates. The interactive fixed-effects model, which controls for unmeasured spatial and temporal confounders, including unmeasured time-varying confounders in different spatial units, can be used to estimate associations between changes in short-term exposure to air pollution and changes in health outcomes.

Dataset Information

Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study.

Publications

Short term exposure to fine particulate matter and hospital admission risks and costs in the Medicare population: time stratified, case crossover study.

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