Health Outcomes

• Single

Health Outcome List:

• Birth outcomes (preterm birth)

Environmental Agents

List of Environmental Agents:

• Air pollutants (particulate matter (PM2.5/fine))

Source of Environmental Agents:

• Not available

Economic Evaluation / Methods and Source

Type:

• Cost benefit analysis (CBA)

Cost Measures:

• Cost of illness estimates for PTB, including incremental medical costs associated with maternal delivery, incremental medical care costs from birth to age 5 years, early intervention costs, or costs of targeted services for children from birth to age 3 who have developmental delays or other delay-related health conditions
• Medical care, special education, and individual lost productivity costs for four developmental disabilities experienced by a subset of individuals born preterm (cerebral palsy, intellectual disability, vision impairment, and hearing loss)
• Cost of illness and willingness to pay estimates for IQ deficits, asthma, diabetes mellitus (types 1 and 2) associated with preterm birth

Potential Cost Measures:

• Costs after age 5 for development disorders experienced by a subset of individuals born preterm (cerebral palsy, intellectual disability, vision impairment, and hearing loss)
• Lost productivity costs for parents of the person born preterm

Benefits Measures:

• Reduced number of preterm birth cases attributable to decreased ambient PM2.5 levels, monetized benefits of immediate and later-life consequences of reduced PTB cases

Potential Benefits Measures:

• Not available

Location:

• Continental United States

Models Used:

• Environmental Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) (US EPA)

Models References:

• https://www.epa.gov/benmap

Methods Used:

• The authors quantified economic benefits associated with a reduction in preterm births (PTBs) attributable to PM2.5 exposure in the United States. The authors’ primary analysis involved using a recent meta-analysis, county-level air quality data, and county-level PTB prevalence data to estimate the potential health and economic benefits. Their supplemental analysis assessed additional later-life outcomes that may be avoided as a result of reduced PTB and the associated economic benefits. For the primary analysis, the authors — 1) used BenMAP to estimate the potential PTB benefits of a reduction in ambient concentrations of county-level PM2.5 nationwide; 2) calculated health impact and valuation results at the county level then aggregated data to state-level and national estimates; 3) used daily 24-hour mean PM2.5 measurements reported to the EPA Air Quality System to estimate baseline county-level air quality and simulated a 10% decrease in annual average county-level PM2.5; 4) obtained numbers and PTBs and births in each county from CDC WONDER; 5) used an existing meta-analysis from 2015 to derive health impact function relating PM2.5 and PTB; and 6) calculated monetized benefits of reduction in PTB resulting from the simulated air quality improvement within BenMAP. For the supplemental analysis, the authors — 1) assessed other studies that documented willingness to pay or cost of illness of PTB including IQ deficits, asthma, and diabetes mellitus (types 1 and 2), and provided meta-analyses of their relationship with PTB; and 2) performed benefits calculations at the national level to provide a broad overview of these potential benefits.

Sources Used:

• United States Census data (United States Environmental Protection Agency, 2017a); daily 24-hour mean PM2.5 measurements reported to the United States EPA Air Quality System from ambient air monitoring stations in 2008; fertility rates for women ages 15-44 (Centers for Disease Control and Prevention, 2016); numbers of PTBs and all births in each county (CDC WONDER, 2008); β coefficient for health impact function relating PM2.5 and PTB (Sun et al., 2015); report on PTB and cost of illness estimate (Institute of Medicine, 2007); meta-analysis of relationship between PTB and IQ deficits (Kerr-Wilson et al., 2012); relationship between PTB and school-age asthma (Sonnenschein-van der Voort et al., 2014); estimate of annual WTP for asthma control (Blomquist et al., 2011); meta-analysis of PTB and diabetes mellitus, types 1 and 2 (Li et al., 2014); annual costs per case of diabetes (American Diabetes Association, 2013); estimated lifetime medical costs and income loss from type 1 diabetes (Tao et al., 2010); numbers and PTBs and births in each county (CDC WONDER, 2008); additional sources cited in publication

Economic Citation / Fundings

Citation:

• Kim JJ, Axelrad DA, Dockins C. Preterm birth and economic benefits of reduced maternal exposure to fine particulate matter. Environmental Research. 2018. 170.
• Pubmed
• DOI

NIEHS Funding:

• Not available

Other Funding:

• Supported by the Cooperative Agreement Number X3–83555301 between the United States Environmental Protection Agency and the Association of Schools and Programs of Public Health during the first author's ASPPH Environmental Health Fellowship at the National Center for Environmental Economics, Office of Policy