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Your Environment. Your Health.

Cost of near-roadway and regional air pollution-attributable childhood asthma in Los Angeles County

Environmental Health Economic Analysis Annotated Bibliography


Research article Cost analysis (CA)
Brandt S, Perez L, Kunzli N, Lurmann F, Wilson J, Pastor M, and Mcconnell R
J Allergy Clin Immunol
This cost analysis study estimated the cost of childhood asthma attributable to residential near-roadway air pollution (NRP) exposure, regional ozone (O3), and nitrogen dioxide (NO2) in Los Angeles County by developing a novel approach to apportion the costs between these exposures under different pollution scenarios. They estimated that the annual cost of asthma for Los Angeles County in 2007 attributable to O3 and NO2 was approximately $441 million and $202 million, respectively, and that costs from increased NRP exposure may offset savings from reduced regional air pollution. The authors concluded that disaggregating the effects of regional air pollution and NRP exposure helps clarify the health co-benefits and cost savings that could be achieved by reducing these exposures.
Children (≤ 17 years)

Health Outcomes

  • Respiratory outcomes (asthma, asthma exacerbation-related outcomes such as bronchitis episodes, ear, and sinus infections)

Environmental Agents

List of Environmental Agents:

  • Air pollutants (near-roadway air pollution, ozone (O3), nitrogen dioxide (NO2))

Source of Environmental Agents:

  • Residential near-roadway air pollution, regional ozone (O3), and nitrogen dioxide (NO2)

Economic Evaluation / Methods and Source


  • Cost analysis (CA)

Cost Measured:

  • Costs of hospitalization
  • inpatient hospital stays
  • emergency room visits
  • doctor visits
  • asthma inhalers and drugs
  • caregiver’s time spent traveling, waiting, and receiving care for office visits, ER visits, and hospitalizations
  • medication use and treatment for asthma-related comorbidities (e.g., ear and sinus infections)
  • school absences
  • antibiotics prescriptions

Potential Cost Measures:

  • Lower lifetime earnings for caregivers of children with asthma
  • costs associated with adult asthma

Benefits Measures: (Not available)

Potential Benefits: (Not available)


  • Los Angeles County, California

Models Used:

  • Yes

Methods Used:

  • The authors estimated the cost of childhood asthma attributable to residential near-roadway air pollution, regional ozone, and nitrogen dioxide in Los Angeles County. The authors — 1) used concentration response functions (CRF) to estimate the prevalence of asthma attributable to near-roadway air pollution; 2) integrated results from a study of willingness to pay to reduce the burden of asthma with studies of health care utilization and charges to estimate the costs of an asthma case and exacerbation; and 3) applied those costs to the number of asthma cases and exacerbations due to regional pollution in 2007 and to hypothetical scenarios of a 20% reduction in regional pollution in combination with a 20% reduction or increase in the proportion of families living in proximity to a major roadway relative to 2007 levels.

Sources Used:

  • Southern California Children's Health Study (2007); Final 2012 Air Quality Management Plan (South Coast Air Quality Management District, 2013); Healthcare Cost and Utilization Project (Agency for Healthcare Research and Quality, 2011); American Academy of Pediatricians Medicaid Reimbursement Survey 2007/2008; Agency for Healthcare Research and Quality (2004); Epocrates (2010); National Household Travel Survey (U.S. Department of Transportation/Federal Highway Administration, Bureau of Transportation Statistics, and National Highway Traffic Safety Administration, 2009); National Health Statistics Reports (2008) National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary; US Census Bureau (2012); California Health Interview Survey (2009); Health care utilization and cost in children with asthma and selected comorbidities (Grupp-Phelan et al., 2001); Medical Expenditure Panel Survey (2007); Contingent valuation scenarios for chronic illnesses: The case of childhood asthma (Brandt et al., 2012); additional sources cited in publication

Economic Evaluation / Methods and Source


  • Brandt S, Perez L, Kunzli N, Lurmann F, Wilson J, Pastor M, and Mcconnell R. 2014. Cost of near-roadway and regional air pollution-attributable childhood asthma in Los Angeles County. J Allergy Clin Immunol.
  • Pubmed
  • DOI

NIEHS Funding:

  • R01ES016535, P01ES011627, P30ES007048, P01ES009581, 5R01ES014447

Other Funding:

  • EPA grants: R826708, RD831861, R831845
  • South Coast Air Quality Management District
  • The Hastings Foundation
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