Improved accounting of the health costs of air pollution in the United States

Air pollution exposure poses health and economic burdens, but most assessments of air pollution in the United States do not account for known variation in costs of hospital admissions and emergency department (ED) visits by race/ethnicity or region, nor do they include ambulatory care and other health-related costs. Given that medical cost data are used regularly in policy and regulatory analyses of air pollution, it is important that these data be finely resolved and comprehensive. We estimate hospital admission and ED visit costs by region, race/ethnicity, and payer type for cardiovascular, respiratory, and neurological health outcomes associated with fine particulate matter (PM2.5) exposure that are included in the Environmental Benefits Mapping and Analysis Program–Community Edition. We also determine additional costs associated with outpatient surgeries, home health care, and prescribed medicines. We then apply these cost data to PM2.5 air quality improvement scenarios to assess their effect on monetized benefit totals. Regional hospital admission and ED visit costs differ from the national average by as much as –34% to +65%. Asian Americans incur the highest per-event costs for most outcomes. White and Black Americans generally incur below-average per-event costs for hospital admissions, and Black and Hispanic Americans incur below-average per-event costs for ED visits. Additional costs greatly increase the total cost of medical events for cardiovascular disease outcomes and hospital admissions for Parkinson’s disease and respiratory diseases (ages 18). When stratifying medical costs by race/ethnicity and region and including additional costs, monetized benefits increase by 64% under the revised National Ambient Air Quality Standard for annual PM2.5 exposure. The effect of cost stratification is less pronounced in scenarios in which PM2.5 reductions are more widespread. We recommend that stratified health cost data be considered for use in policy and regulatory analysis, particularly in work considering health equity implications of air pollution exposure.