OBJECTIVE To assess risks and costs of hospital admission associated with short term exposure to fine particulate matter with diameter less than 2.5 µm (PM2.5) for 214 mutually exclusive disease groups. DESIGN Time stratified, case crossover analyses with conditional logistic regressions adjusted for non-linear confounding effects of meteorological variables. SETTING Medicare inpatient hospital claims in the United States, 2000-12 (n=95 277 169). PARTICIPANTS All Medicare fee-for-service beneficiaries aged 65 or older admitted to hospital. MAIN OUTCOME MEASURES Risk of hospital admission, number of admissions, days in hospital, inpatient and post-acute care costs, and value of statistical life (that is, the economic value used to measure the cost of avoiding a death) due to the lives lost at discharge for 214 disease groups. RESULTS Positive associations between short term exposure to PM2.5 and risk of hospital admission were found for several prevalent but rarely studied diseases, such as septicemia, fluid and electrolyte disorders, and acute and unspecified renal failure. Positive associations were also found between risk of hospital admission and cardiovascular and respiratory diseases, Parkinson's disease, diabetes, phlebitis, thrombophlebitis, and thromboembolism, confirming previously published results. These associations remained consistent when restricted to days with a daily PM2.5 concentration below the WHO air quality guideline for the 24 hour average exposure to PM2.5. For the rarely studied diseases, each 1 µg/m3 increase in short term PM2.5 was associated with an annual increase of 2050 hospital admissions (95% confidence interval 1914 to 2187 admissions), 12 216 days in hospital (11 358 to 13 075), US$31m (£24m, €28m; $29m to $34m) in inpatient and post-acute care costs, and $2.5bn ($2.0bn to $2.9bn) in value of statistical life. For diseases with a previously known association, each 1 µg/m3 increase in short term exposure to PM2.5 was associated with an annual increase of 3642 hospital admissions (3434 to 3851), 20 098 days in hospital (18 950 to 21 247), $69m ($65m to $73m) in inpatient and post-acute care costs, and $4.1bn ($3.5bn to $4.7bn) in value of statistical life. CONCLUSIONS New causes and previously identified causes of hospital admission associated with short term exposure to PM2.5 were found. These associations remained even at a daily PM2.5 concentration below the WHO 24 hour guideline. Substantial economic costs were linked to a small increase in short term PM2.5.

中文翻译：

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医疗保险人群短期接触细颗粒物以及入院风险和费用：时间分层、病例交叉研究。


目的 评估 214 个相互排斥的疾病组与短期暴露于直径小于 2.5 µm 的细颗粒物 (PM2.5) 相关的入院风险和费用。设计时间分层案例交叉分析，并根据气象变量的非线性混杂效应调整条件逻辑回归。 2000 年 12 月美国医疗保险住院索赔情况（n=95 277 169）。参与者 所有 65 岁或以上住院的 Medicare 按服务收费受益人。主要观察指标 因生命而入院的风险、入院次数、住院天数、住院和急性期后护理费用以及统计生命价值（即用于衡量避免死亡成本的经济价值）出院时丢失 214 个疾病组。结果 短期暴露于 PM2.5 与入院风险之间存在正相关关系，这与几种常见但很少研究的疾病有关，例如败血症、液体和电解质紊乱以及急性和未明确的肾功能衰竭。入院风险与心血管和呼吸系统疾病、帕金森病、糖尿病、静脉炎、血栓性静脉炎和血栓栓塞之间也发现呈正相关，证实了之前发表的结果。当每日 PM2.5 浓度低于世界卫生组织 24 小时平均 PM2.5 空气质量指南的天数时，这些关联仍然保持一致。对于很少研究的疾病，短期 PM2.5 每增加 1 µg/m3。5 与每年增加 2050 例入院人数（95% 置信区间为 1914 年至 2187 例入院人数）、住院时间 12 216 天（11 358 至 13 075 人）、3100 万美元（2400 万英镑、2800 万欧元；2900 万美元至 3400 万美元）相关）住院和急性后护理费用，以及统计生命价值 25 亿美元（20 亿至 29 亿美元）。对于先前已知关联的疾病，短期 PM2.5 暴露量每增加 1 µg/m3，每年就会增加 3642 例入院病例（3434 例至 3851 例）、住院天数 20 098 天（18 950 例至 21 247 例） ，住院和急性期后护理费用为 6900 万美元（6500 万美元至 7300 万美元），统计生命价值为 41 亿美元（35 亿美元至 47 亿美元）。结论 发现了与短期暴露于 PM2.5 相关的新的入院原因和先前确定的入院原因。即使每日 PM2.5 浓度低于世界卫生组织 24 小时指南，这些关联仍然存在。短期 PM2.5 的小幅增加会带来巨大的经济成本。