Zurl Hanna, Qian Zhiyu, Stelzl Daniel R, Dagnino Filippo, Korn Stephan M, Labban Muhieddine, Lipsitz Stuart R, Leitsmann Marianne, Ahyai Sascha, Ellimoottil Chad, Loeb Stacy, Iyer Hari S, Trinh Quoc-Dien, Cole Alexander P
Department of Urology, Medical University of Graz, Graz, Austria.
Department of Urology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
JAMA Netw Open. 2025 Mar 3;8(3):e252513. doi: 10.1001/jamanetworkopen.2025.2513.
The US health care sector accounts for about 8.5% of national greenhouse gas (GHG) emissions. Reliable estimates of emissions associated with health care-related travel are essential for informing policy changes.
To generate a comprehensive national estimate of carbon emissions due to patient health care-related travel in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 2022 National Household Travel Survey (NHTS), conducted from January 2022 to January 2023. Participants were selected using an address-based sample from the US Postal Service Delivery Sequence File. Participating households reported all trips taken within 24 hours by all household members aged 5 years or older. Approximate emissions per mile were obtained from typical vehicle emissions data provided by US government institutions. Data were analyzed between March 11 and May 29, 2024.
Estimated annual CO2 equivalent (CO2e) emissions from patient health care-related travel per year, per patient, per trip, and per mile. A survey-weighted λ regression analysis was used to identify factors associated with higher CO2e emissions per trip. An alternative scenario analysis estimated reductions if 30% or 50% of private vehicle users switched to electric vehicles.
The sample included 16 997 participants with a weighted total of 3 506 325 536 US health care trips. Of these trips, 52.0% were reported by female travelers, 80.1% were made in urban areas, and 19.9% were made in rural areas. These trips accounted for 84 057 963 340 miles, resulting in weighted annual estimated emissions of 35.7 megatons (Mt) (95% CI, 27.5-43.9 Mt) CO2e. Each mile traveled generated an estimated 424 g (95% CI, 418-428 g) CO2e. Emissions per trip were higher (exponentiated coefficient [exp(β)], 2.19; 95% CI, 1.51-2.86; P < .001) for rural patients compared with urban patients. However, 69.3% of emissions were attributable to urban patients and 30.7% to rural patients. Patients with annual median household incomes of $50 000 to $99 999 generated higher trip emissions (exp[β], 1.92; 95% CI, 1.09-2.76; P = .003) compared with those with incomes of $25 000 or less. A 30% shift to electric vehicles was estimated to reduce health care-related carbon emissions to 27.6 Mt (95% CI, 20.7-34.6 Mt) CO2e, and a 50% shift was estimated to lower emissions to 22.3 Mt (95% CI, 16.0-28.6 Mt) CO2e.
This cross-sectional study estimated that annual patient health care-related travel in the US generated 35.7 Mt CO2e, which accounts for a small but important proportion of total health care-related emissions in the US. These findings are essential for informing health care policy decisions and suggest that strategies such as telehealth and the adoption of electric vehicles may contribute to a small but significant reduction in health care-related GHG emissions.
美国医疗保健部门约占全国温室气体（GHG）排放量的8.5%。准确估算与医疗保健相关出行的排放量对于指导政策变化至关重要。
对美国患者因医疗保健相关出行产生的碳排放进行全面的全国性估算。
设计、背景和参与者：这项横断面研究使用了2022年1月至2023年1月进行的2022年全国家庭出行调查（NHTS）的数据。参与者是从美国邮政服务投递顺序文件中基于地址的样本中选取的。参与家庭报告了所有5岁及以上家庭成员在24小时内进行的所有出行。每英里的近似排放量来自美国政府机构提供的典型车辆排放数据。数据于2024年3月11日至5月29日进行分析。
估算每年、每位患者、每次出行以及每英里因患者医疗保健相关出行产生的二氧化碳当量（CO2e）排放量。使用调查加权λ回归分析来确定与每次出行较高CO2e排放量相关的因素。一项替代情景分析估计了如果30%或50%的私家车使用者改用电动汽车，排放量的减少情况。
样本包括16997名参与者，加权后的美国医疗保健出行总数为3506325536次。在这些出行中，52.0%由女性出行者报告，80.1%在城市地区进行，19.9%在农村地区进行。这些出行共计84057963340英里，导致加权年度估计排放量为35.7兆吨（Mt）（95%置信区间，27.5 - 43.9 Mt）CO2e。每行驶一英里估计产生424克（95%置信区间，418 - 428克）CO2e。与城市患者相比，农村患者每次出行的排放量更高（指数系数[exp(β)]，2.19；95%置信区间，1.51 - 2.86；P <.001）。然而，69.3%的排放量归因于城市患者，30.7%归因于农村患者。家庭年收入中位数为50000美元至99999美元的患者与收入为25000美元或以下的患者相比，每次出行产生的排放量更高（exp[β]，1.92；95%置信区间，1.09 - 2.76；P = 0.003）。估计30%改用电动汽车将使医疗保健相关碳排放降至27.6 Mt（95%置信区间：20.7 - 34.6 Mt）CO2e，50%改用电动汽车估计将排放量降至22.3 Mt（95%置信区间：16.0 - 28.6 Mt）CO2e。
这项横断面研究估计，美国每年患者因医疗保健相关出行产生35.7 Mt CO2e，这在美国医疗保健相关总排放量中占比虽小但很重要。这些发现对于为医疗保健政策决策提供信息至关重要，并表明远程医疗和采用电动汽车等策略可能有助于小幅但显著减少医疗保健相关的温室气体排放。
