The Burden of Disease Hospitalization due to Coal Burning in Beijing

Abstract

Background/Aim: Coal plays an irreplaceable role in the energy use in China, however, it causes severe air pollution and adverse health impacts, i.e. outpatient /emergency visit, hospital admission, and death. Hospital admission of the exposed population costs large direct medical expenses, but its quantitative estimate is rarely studied in China. In this article we evaluated the direct economic burden caused by hospital admissions due to coal burning in Beijing. Methods: The data of daily air quality and hospital admissions with the related medical expenses for ischemic heart disease (IHD), lung cancer (LC), chronic obstructive pulmonary disease (COPD) and stroke in Jan 1st, 2013-Oct 22nd, 2014 were collected in Beijing. Time series study using a generalized additive model was used to evaluate the exposure-response relationship between PM2.5 concentration and hospital admission (for the four diseases as a whole and each). With the contribution rate of coal burning for PM2.5 and the insurance rate in Beijing, the extra hospital admissions caused by coal burning was estimated, and then the mean medical expenses were used to figure out the economic burden. Results: The daily average concentration of PM2.5 was 89.90 (6.28-397.30) μg/m3 during the study period. 162,009 patients were admitted for the four diseases, with a daily average of 247 inpatients. An increase of 10μg/m3 of PM2.5 could increase the risk of hospital admission for the four diseases by 0.66% (95%CI: 0.59%, 0.73%). Accordingly, at least 2287 extra inpatients occurred because of coal burning, with the total economic loss of 65.69 million RMB. The highest two extra inpatient numbers were from IHD (at least 898, 39.27%) and stroke (at least 868, 37.95%), which caused about 41.85% and 28.94% of the total medical expenses. Conclusions: Coal burning caused adverse health impact and huge economic burden on the exposed population in Beijing, especially on IHD and stroke patients.