Poor Air Quality Leads to More Hospital Costs, Says RAND

Automobile manufacturers, petroleum product producers or polluting factories could be likely candidates, he says.

The study is the first of its kind to equate hospitalizations throughout the state with air pollution, and did so on a county-by-county basis based on levels of pollution in those areas, said the authors. It reviewed costs associated with admissions to acute care hospitals for patients with cardiovascular and respiratory diseases, and for patients treated in emergency rooms for asthma.

Romley used hospital discharge cost statistics maintained by the Office of Statewide Planning and Development and used statistical modeling to account for respiratory or cardiovascular illnesses that instead were caused by lifestyle factors, such as smoking, bad diet, occupational risks or obesity.

The report, entitled "The Impact of Air Quality on Hospital Spending," did not factor in the cost of office visit care provided by physicians or anywhere else, such as outpatient settings, or other costs of these illnesses, such as loss of work.

Excess particulate matter causes heart attacks, acute and chronic bronchitis, and asthma. And ozone in excess significantly contributes to respiratory events, such as asthma attacks and other respiratory conditions and lung function constrictions, according to the report.

"We only looked at those areas where there is ample evidence that higher levels of pollution at various points will cause this many illnesses," Romley says.

Also, the most affected areas in the state are those with the most people, such as nearly all of coastal Southern California, the San Joaquin Valley, the San Francisco Bay area, and metropolitan Sacramento.

For example, in Fresno, one of the high particulate pollution areas of the state, failure to meet federal air standards meant 384 patients had to be admitted to St. Agnes Medical Center or were treated in the emergency department, totaling nearly $3 million. Nearly two-thirds of that cost was paid by Medicare, according to the report.

In Lynnwood, just south of Los Angeles, which fails to meet federal clean air rules, 295 patients were admitted to St. Francis Medical Center's inpatient units or were treated in its emergency room at a cost of $1.2 million, the reported added.

The report also broke down spending by health plan. For example, Kaiser Foundation Health Plan Inc. spent $30 million for 1,827 patient care events that would have been avoided had those areas of the state met air pollution standards. Secure Horizons was next with $10.4 million for 899 patient care events.

As expected, high pollution counties in the state had the highest spending. Los Angeles County care related to illnesses caused by smog had the highest expenditures, followed by San Bernardino and Orange Counties, RAND reported.