Environmental Health Division, Department of Environmental Engineering, Graduate School of Engineering, Kyoto University, Kyoto, Japan; Department of Global Ecology, Graduate School of Global Environmental Studies, Kyoto University, Kyoto, Japan.
Department of Health Care Policy and Health Economics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
Environ Int. 2018 Nov;120:525-534. doi: 10.1016/j.envint.2018.08.037. Epub 2018 Aug 25.
Previous studies have highlighted the negative effects of PM on mortality, expressed in terms of attributable deaths and life years lost. However, there are very few studies assessing the health impacts of air pollution in terms of economic burden/benefits. This study assessed the health impact of two hypothetical interventions among sex- and age-specific risk populations using a robust risk estimation and economic valuation process. We utilized the sex- and age-stratified daily all-cause mortality together with the daily PM of the 9 Japanese cities from 2002 to 2008 in estimating the relative risks. The estimated risks were then utilized for the economic valuation of co-benefits/burden with respect to the two hypothetical PM-related mitigation scenarios, in comparison to status quo, namely: i) decrease to Japanese standards, and ii) decrease to WHO standards. Impact of these interventions on health were assessed using the following HIA metrics: attributable mortality, attributable years life lost, and environmental health impact. A 10-μg/m increase in PM would increase the risk by 0.52% (95% CI: -0.91% to 1.99%) for all-cause mortality, with varying risk estimates per subgroup. High economic burdens were estimated at status quo, with particularly distinct burden difference for age-specific mortality; 0.40 trillion yen (0-64 y.o.) and 1.50 trillion yen (>64 y.o.). If stricter standards, relative to status quo, were to be enforced, i.e. WHO standard, there is a potential to yield economic benefits in the same risk population; 0.26 trillion yen (0-64 y.o.) and 0.98 trillion yen (>64 y.o.). We did not observe any substantial difference with the burden and benefit related to sex-specific mortality. Using the estimated local risk coefficients complemented with the valuation of the risks, policymaking entities will have the opportunity to operate their own HIA to assess the relevant air pollution-related health impacts.
先前的研究强调了 PM 对死亡率的负面影响，用归因死亡人数和生命损失年来表示。然而，评估空气污染对经济负担/效益的健康影响的研究非常少。本研究使用稳健的风险估计和经济估值过程，评估了两种假设的干预措施对特定性别和年龄风险人群的健康影响。我们利用 2002 年至 2008 年日本 9 个城市的性别和年龄分层的全因每日死亡率以及每日 PM 来估计相对风险。然后，我们利用估计的风险来评估两种假设的与 PM 相关缓解情景（与现状相比）的共同效益/负担的经济价值，即：i）降低到日本标准，ii）降低到世卫组织标准。利用以下 HIA 指标评估这些干预措施对健康的影响：归因死亡率、归因生命损失年和环境卫生影响。PM 增加 10μg/m 会使全因死亡率的风险增加 0.52%（95%CI：-0.91%至 1.99%），每个亚组的风险估计值不同。在现状下，预计经济负担很高，特定年龄组的死亡率差异尤为明显；0.40 万亿日元（0-64 岁）和 1.50 万亿日元（>64 岁）。如果实施更严格的标准，与现状相比，即世卫组织标准，相同风险人群可能会产生经济效益；0.26 万亿日元（0-64 岁）和 0.98 万亿日元（>64 岁）。我们没有观察到与特定性别死亡率相关的负担和效益有任何实质性差异。使用估计的本地风险系数并结合风险的估值，决策实体将有机会进行自己的 HIA，以评估相关的空气污染对健康的影响。
