Burden of cardiovascular diseases associated with fine particulate matter in Beijing, China: an economic modelling study

OBJECTIVE: To evaluate the economic and humanistic burden associated with cardiovascular diseases that were attributable to fine particulate matter (≤ 2.5 μg/m(3) in aerodynamic diameter; PM(2.5)) in Beijing. METHODS: This study used a health economic modelling approach to compare the actual annual average PM(2.5) concentration with the PM(2.5) concentration limit (35 µg/m(3)) as defined by the Chinese Ambient Air Quality Standard in terms of cardiovascular disease outcomes in Beijing adult population. The outcomes included medical costs, quality-adjusted life-years (QALYs) and net monetary loss (NML). Beijing annual average PM(2.5) concentration was around 105 µg/m(3) during 2013–2015. Therefore, we estimated the differences in cardiovascular outcomes of Beijing adults between exposure to the PM(2.5) concentration of 105 µg/m(3) and exposure to the concentration of 35 µg/m(3). According to WHO estimates, the hazard ratios of coronary heart disease and stroke associated with the increase of PM(2.5) concentration from 35 to 105 µg/m(3) were 1.15 and 1.29, respectively. RESULTS: The total 1-year excess medical costs of cardiovascular diseases associated with PM(2.5) pollution in Beijing was US$147.9 million and the total 1-year QALY loss was 92 574 in 2015, amounting to an NML of US$2281.8 million. The expected lifetime incremental costs for a male Beijing adult and a female Beijing adult were US$237 and US$163, the corresponding QALY loss was 0.14 and 0.12, and the corresponding NML was US$3514 and US$2935. CONCLUSIONS: PM(2.5)-related cardiovascular diseases imposed high economic and QALY burden on Beijing society. Continuous and intensive investment on reducing PM(2.5) concentration is warranted even when only cardiovascular benefits are considered.