Wang Siyuan, Jiang Yawen, Xu Zhiwei, Di Tanna Gian Luca, Lewis Sarah, Chen Mingsheng, Downey Laura, Jan Stephen, Si Lei
The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia.
School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, China.
BMJ Glob Health. 2024 Dec 5;9(12):e016974. doi: 10.1136/bmjgh-2024-016974.
China faces the dual challenge of high air pollution and an increasing burden of cardiovascular disease (CVD). We aimed to estimate the healthcare costs associated with CVD and the quality-adjusted life years (QALYs) under scenarios of improved air quality in China.
A health prediction model was developed to estimate 10-year CVD-related costs and QALY associated with PM2.5 levels in 2015, as well as two hypothetical improved air quality scenarios: (1) the China national PM2.5 target of 35 µg/m³, and (2) the World Health Organization's (WHO) PM2.5 guideline of 5 µg/m³. Population CVD risks were estimated from the 2015 China Health and Retirement Longitudinal Study. Hazard ratios from WHO risk curves were subsequently applied to baseline cardiovascular risks to predict national 10-year estimates of ischaemic stroke and coronary heart disease-related healthcare expenditures and QALYs for individuals aged 45-85 under the three air quality scenarios.
Under PM2.5 levels in 2015, we estimated a cumulative 10-year incidence of 35.40 million CVD events, resulting in healthcare costs of US$96.12 billion and 4.44 billion QALYs. Under the national target of 35 µg/m³, the projected 10-year CVD incidence was 31.92 million cases, resulting in cost savings of US$9.29 billion and 3.43 million QALY gains compared with 2015 levels. If PM2.5 concentration levels meet the WHO's guideline of 5 µg/m³, the projected number of CVD events would decrease to 24.18 million, translating to cost savings of approximately US$30.10 billion and gains of 11.29 million QALYs.
Our findings indicate that achieving the WHO recommended PM2.5 concentration level of 5 µg/m³ could lead to over threefold greater health and economic benefits than those achievable under national standards of 35 µg/m³. This underscores the potential need for stricter future national PM2.5 standards. Our findings also inform other low- and middle-income countries in establishing effective long-term PM2.5 targets.
中国面临着空气污染严重和心血管疾病（CVD）负担日益加重的双重挑战。我们旨在估算在中国空气质量改善情景下与心血管疾病相关的医疗费用及质量调整生命年（QALY）。
开发了一种健康预测模型，以估算2015年与PM2.5水平相关的10年心血管疾病相关费用和QALY，以及两种假设的空气质量改善情景：（1）中国PM2.5国家标准35µg/m³，（2）世界卫生组织（WHO）的PM2.5准则5µg/m³。根据2015年中国健康与养老追踪调查估算人群心血管疾病风险。随后将WHO风险曲线中的风险比应用于基线心血管疾病风险，以预测三种空气质量情景下45 - 85岁人群10年缺血性中风和冠心病相关医疗支出及QALY的全国估算值。
在2015年的PM2.5水平下，我们估计10年心血管疾病累计发病率为3540万例，导致医疗费用961.2亿美元和44.4亿QALY。在35µg/m³的国家标准下，预计10年心血管疾病发病率为3192万例，与2015年水平相比节省费用92.9亿美元，QALY增加343万。如果PM2.5浓度水平符合WHO的5µg/m³准则，预计心血管疾病事件数量将降至2418万例，节省费用约301.0亿美元，QALY增加1129万。
我们的研究结果表明，实现WHO建议的5µg/m³的PM2.5浓度水平，可能带来比35µg/m³国家标准下大三倍以上的健康和经济效益。这凸显了未来可能需要更严格的国家PM2.5标准。我们的研究结果也为其他低收入和中等收入国家制定有效的长期PM2.5目标提供了参考。
