Burden of cardiovascular diseases associated with fine particulate matter in Beijing, China: An economic modelling study

Abstract

Objective To evaluate the economic and humanistic burden associated with cardiovascular diseases that were attributable to fine particulate matter (≤ 2.5 μg/m 3 in aerodynamic diameter; PM 2.5) in Beijing. Methods This study used a health economic modelling approach to compare the actual annual average PM 2.5 concentration with the PM 2.5 concentration limit (35 μg/m 3) as defined by the Chinese Ambient Air Quality Standard in terms of cardiovascular disease outcomes in Beijing adult population. The outcomes included medical costs, quality-adjusted life-years (QALYs) and net monetary loss (NML). Beijing annual average PM 2.5 concentration was around 105 μg/m 3 during 2013-2015. Therefore, we estimated the differences in cardiovascular outcomes of Beijing adults between exposure to the PM 2.5 concentration of 105 μg/m 3 and exposure to the concentration of 35 μg/m 3. According to WHO estimates, the hazard ratios of coronary heart disease and stroke associated with the increase of PM 2.5 concentration from 35 to 105 μg/m 3 were 1.15 and 1.29, respectively. Results The total 1-year excess medical costs of cardiovascular diseases associated with PM 2.5 pollution in Beijing was US$147.9 million and the total 1-year QALY loss was 92 574 in 2015, amounting to an NML of US$2281.8 million. The expected lifetime incremental costs for a male Beijing adult and a female Beijing adult were US$237 and US$163, the corresponding QALY loss was 0.14 and 0.12, and the corresponding NML was US$3514 and US$2935. Conclusions PM 2.5 -related cardiovascular diseases imposed high economic and QALY burden on Beijing society. Continuous and intensive investment on reducing PM 2.5 concentration is warranted even when only cardiovascular benefits are considered.