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Your Environment. Your Health.

Costs of coronary heart disease and mortality associated with near-roadway air pollution

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost analysis (CA)
Brandt S, Dickinson B, Ghosh R, Lurmann F, Perez L, Penfold B, Wilson J, Kunzli N, Mcconnell R
Science of the Total Environment
This cost analysis estimated cost associated with CHD burden attributable to PM2.5 and NRAP in Southern California in 2008 and 2035. The authors calculated that, in 2008, CHD mortality due to NRAP cost $4 - $12 billion, and near-roadway-attributable hospitalization for heart disease cost $48.6 million. The authors also estimated that the cost of NRAP-attributable heart disease is projected to increase to $51.4 million in 2035, due largely to an aging population. The authors concluded that the value of mortality from CHD attributable to NRAP in Southern California in 2008 was a substantial proportion of the estimated $16.8 billion value of PM2.5-attributable CHD mortality. The authors conclude that the typically estimated PM2.5-attributable costs may underestimate the true cost of air pollution.
Aging population (≥45 years)

Health Outcomes

  • Cardiovascular outcomes (coronary heart disease, coronary heart disease mortality)
  • Mortality

Environmental Agents

List of Environmental Agents:

  • Air pollutants (near-roadway air pollution (NRAP), particulate matter (PM2.5 fine))

Source of Environmental Agents:

  • Traffic

Economic Evaluation / Methods and Source


  • Cost analysis (CA)

Cost Measured:

  • Direct cost of the hospitalization
  • Cost of CHD-related medical care during the year following discharge for CHD (e.g., outpatient treatment, medical office visits, and pharmaceutical treatment)
  • Indirect costs of CHD hospitalization to the individual as lost income above what is covered by short-term disability insurance
  • Opportunity costs associated with the value of time that could have been spent on activities if not for the CHD
  • Total costs of hospitalization (sum of direct, indirect, and opportunity costs)

Potential Cost Measures:

  • CHD-related costs associated with effects after one year (e.g, persistent fatigue, depression, not returning to work, complications from inpatient care)

Benefits Measures: (Not available)

Potential Benefits: (Not available)


  • California's South Coast Air Basin (SoCAB) consisting of the densely populated southern part of Los Angeles County, western urbanized portions of Riverside and San Bernardino counties, and all of Orange County

Models Used: (Not available)

Methods Used:

  • The authors calculated the costs of coronary heart disease (CHD) and CHD mortality in a coastal region of Southern California in 2008 from NRAP exposures and estimated costs in 2035 based on projected population changes and NRAP levels. The authors — 1) used previously derived estimates of population-weighted exposure, the pollution-attributable fraction, and number of CHD hospitalizations and deaths in 2008 (Ghosh et al., 2015); 2) projected estimates for 2035 under a compact development scenario from the Southern California Regional Transportation Plan; 3) estimated mortality attributable to NRAP and PM2.5 in each county in SoCAB and SoCAB overall in 2008 and 2035 using three measures of NRAP: proximity to a major roadway, elemental carbon, and traffic density; 4) calculated the total value of mortality by multiplying the number of deaths by the value of a statistical life of $8.8 million in 2014 dollars; 4) calculated direct costs of CHD hospitalizations by summing the mean cost of hospitalization, the average direct medical costs incurred during the year following discharge; and follow up costs including outpatient treatment, medical office visits, and pharmaceutical treatment; 5) calculated indirect costs of CHD hospitalizations for ages 45-65 years as lost income over the six months following hospitalization after subtracting short-term disability payments; 6) calculated opportunity costs for ages 65+ years as the cost of time lost that would otherwise be spent on leisure and household activities; and 7) calculated total costs as the sum of direct, indirect, and opportunity costs for the two age populations of 45-64 and 65+ years.

Sources Used:

  • Previous estimates of population-weighted exposure and the number of CHD deaths and hospitalizations attributable to NRAP and PM2.5 in 2008 (Ghosh et al., 2015); Healthcare Cost and Utilization Project California database (HCUP State Inpatient Databases, 2011); work and leisure time estimates (US Department of Labor, 2015); a study of selected CHD diagnoses to estimate average direct medical costs after discharge (Zhao and Winget, 2011); CHD-mortality and hospitalization data from International Classification of Diseases (ICD-10 codes 120-125, ICD-9 codes 410-414 and 429.2); value of statistical life in 2014 (US EPA, 2011; US EPA, 2010); additional sources cited in publication

Economic Evaluation / Methods and Source


  • Brandt S, Dickinson B, Ghosh R, Lurmann F, Perez L, Penfold B, Wilson J, Kunzli N, Mcconnell R. 2017. Costs of coronary heart disease and mortality associated with near-roadway air pollution. Science of the Total Environment.
  • Pubmed
  • DOI

NIEHS Funding:

  • P30ES007048, R01ES016535, P01ES009581, P01ES022845, R01ES014708, R01ES014447

Other Funding:

  • U.S. EPA grants
  • funds from an air quality violations settlement
  • and the Hastings Foundation
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