Air Pollution Linked to Increased Medical Care and Costs for Elderly

A new study of elderly Americans shows a strong link between air pollution and higher costs of medical care, both inpatient and outpatient, and especially for respiratory ailments.

Millions of Medicare records of whites between the ages of 65 and 84 from 1989 to 1991 provided a study sample for researchers Victor R. Fuchs, professor emeritus at Stanford University, and Sarah Rosen Franks, a doctoral student at the University of California, Berkeley. They write in the November/December issue of Health Affairs that in addition to improving health, less pollution can mean substantial cost savings.

“This study shows that use of medical care is significantly higher in areas with more pollution and that decreased use of care is an important benefit from pollution control,” Fuchs and Franks report. “Pollution control,” they say, “offers an important opportunity for further gains in health and reductions in medical care spending.”

The researchers examined the medical records and pollution measures in 183 metropolitan areas, adjusting their findings to account for differences in region, population size, education level, income level, percentage of the population that is black, cigarette consumption and obesity.

Comparing cities with the most pollution to those with the least, there was relatively little difference in surgery rates, but there was a 19 percent difference in admissions to a hospital for respiratory conditions. The difference in inpatient care was 7 percent between high-pollution areas and low-pollution areas, but 18 percent for outpatient care.

Air pollution is worst where the population is largest and in the West region, and lowest in Florida and the “Big Sky” region (Rocky Mountain and adjacent states), the researchers found. Inpatient care did not vary much among regions, but outpatient care was twice as high in Florida as in the “Big Sky” region. Hospital admissions were greatest in the Deep South and in the West South (Texas, Oklahoma, Arkansas and Louisiana).

Overall, respiratory admissions showed a “very strong relation” to pollution, although the absolute change is small because of the relatively low number of such admissions.

The authors caution that there is no data that directly links individual health problems to air pollution and that their statistical methods “establish a presumption of causal relationship but do not constitute absolute proof.”

The study was supported by grants from the Robert Wood Johnson Foundation and Kaiser Family Foundation to the National Bureau of Economic Research, Inc.

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