The healthcare costs of poor air quality in Ireland: An analysis of hospital admission

Air pollution is well recognised as a major risk factor for disease and premature mortality worldwide. In Ireland, fine particulate matter (PM2.5), which originates largely from burning solid fuel for heating, and nitrogen dioxide (NO2), derived from road transport, are the main sources contributing to poor air quality. Although average annual air pollution concentrations have decreased in Ireland over the past two decades, there are concerns about exceedances above WHO air quality guidelines (AQGs) in many cities and towns in Ireland. In this paper, we estimate the acute healthcare costs of air pollution in Ireland, using data on emergency inpatient hospital admissions and costs over the period 2016-2019 from the Hospital In-Patient Enquiry (HIPE) system, supplemented with data on population attributable fractions for specific conditions with causal links to air pollution (e.g., asthma). Quantifying the potential impact of air pollution on healthcare costs is important for future policy and resource planning and for targeting of mitigation measures and public health campaigns. Over the four-year period we examine, the acute healthcare costs of treating five conditions attributable to ambient air pollution (asthma in children, and chronic obstructive pulmonary disease, ischaemic heart disease, stroke and asthma in adults) amounted to €56.0m (range €15.0m to €105.8m). Hospitalisations attributable to air pollution (mainly PM2.5) for these five conditions accounted for 63,572 bed days (range 17,767 to 115,996) over the period 2016-2019. In terms of the policy response, the recent Clean Air Strategy commits to achieving the final WHO air quality guideline (ACQ) values by 2040. Achieving these targets will require continued policy focus on measures such as moving away from the burning of solid fuels. In addition, policy measures to mitigate the impacts of climate change, such as decarbonising home heating, promoting active travel and transitioning to electric vehicles, will have concomitant benefits for air quality and population health.