Quantifying the effect of air pollution and temperature on hospitalization costs for chronic lower respiratory...

Environmental exposure is a crucial factor contributing to the increasing health and economic burden of chronic lower respiratory diseases (CLRDs). This study aims to quantify the effects of environmental exposure on hospitalization costs associated with CLRDs and their population heterogeneity, thus providing a scientific basis for formulating more precise and effective cost-control policies.

Hospital admission records from seven major tertiary hospitals in Changchun from 2017 to 2020 were collected, as were environmental monitoring and meteorological data. A generalized additive model and distributed lag nonlinear model were employed to identify the exposure-response relationships and lag effects of pollutants and temperature.

A total of 23,569 patients with CLRDs were included. Most of the participants were male (50.83%) and aged 60 years and older (63.42%), with hospitalization costs accounting for 54.22 and 67.96% of total costs, respectively. When the concentrations of PM2.5, PM10, SO₂, or NO₂ increased by 10 μg/m³, the hospitalization costs on the same day increased by 1.78, 0.87, 8.30, and 4.43%, respectively. The cumulative lag effects of PM2.5, SO₂, and NO₂ peaked after 6 days, whereas those of PM10 peaked after 5 days. Inhalable particulate matter had a greater effect on children aged 0-14 years and those aged 60 years and older, whereas SO₂ and NO₂ had greater effects on those aged 15-59 years. With respect to temperature, the hospitalization costs of people aged 60 and above increased by 8.70% on low-temperature days, and the exposure response ratio from lag day 0 to lag day 5 showed a statistically significant gradual decrease. Additionally, on lag days 5 and 11, the hospitalization costs of female patients with CLRDs increased by 3.35 and 3.92%, respectively.

A significant association was observed between increased air pollutant concentrations and the hospitalization costs of patients with CLRDs, with heterogeneity among different populations. Specifically, the effects of SO₂ and NO₂ were more pronounced, particularly in the 15-59 age group. Moreover, an increase in particulate matter concentration had a greater effect on children and older population. Extreme low-temperature weather significantly affected the hospitalization costs of older population and women with CLRDs.