In May 2004, the American Heart Association acknowledged that chronic exposure to air pollution contributes to the development of cardiovascular diseases (heart disease and stroke) (Brook et al., 2004). Epidemiological studies conducted in the past ten years have shown a consistent, increased risk for cardiovascular events, including cardiac and stroke deaths, related to short- and long-term exposure to present-day concentrations of pollution, especially particulate matter (Brook et al., 2004). Microscopic fine air particulate matter, or PM2.5, has been shown as an important risk factor for mortality from lung cancer and cardiopulmonary disease (Pope et al., 2002). Particulate matter is a byproduct of burning fossil fuels, in particular the burning of diesel gasoline.  Many sources of PM2.5 can be reduced through pollution controls, such as the retrofitting of diesel engines or by increasing air quality standards for machines that produce PM2.5.

Cost Estimates: Using cost estimates based on data from the American Heart Association (2007), we calculated an estimate of the environmentally attributable costs of cardiovascular disease in Oregon. 

According to the 2006 Oregon Heart Disease and Stroke Report, cardiovascular disease is the leading cause of death in Oregon and accounted for 34% of all deaths in 2003 (Dahlin, Leman & Ngo, 2006). The most common causes of cardiovascular disease mortality are heart attack and stroke. In addition to the more than 10,000 deaths caused annually by all forms of cardiovascular disease, thousands of Oregonians are hospitalized each year from cardiovascular disease related events.  According to the State Hospital Discharge Index, there were 32,000 hospitalizations of Oregonians for heart disease, stroke and related disease in 2004, resulting in $781 million in hospital costs (Dahlin et al., 2006). Hospitalization costs, however, reflect only a portion of the full financial burden of cardiovascular disease.  Costs related to outpatient care, prescription medications, rehabilitation, long-term care, and loss of productivity are not included in the above totals and would greatly increase the estimates of the economic burden from cardiovascular disease in Oregon.

The American Heart Association estimated that in 2007 the national costs of cardiovascular disease were $431.8 billion. This figure includes direct health care expenditures (the cost of physicians and other professionals, hospital and nursing home services, the cost of medications, home health care and other medical durables) and indirect costs (lost productivity resulting from morbidity and mortality). The direct health care costs constitute $283.2 billion while indirect costs constitute $148.6 billion of the total.

Environmentally Attributable Factor Range (EAFR) and Best Estimate: Pope et al. (2002) found that for every 10µg/m3 increase of fine particulates, cardiopulmonary deaths rose by 6%.  A 1996 report (Sheiman Shprentz, 1996) used similar mortality risk factors for cardiopulmonary diseases to generate point and range estimates of the annual adult cardiopulmonary deaths attributable to air pollution in 239 U.S. cities.

The data in Sheiman Shprentz (1996) addressed three Metropolitan Statistical Areas in Oregon, including Eugene-Springfield, Medford, and Portland.  The study showed that in 1989 there were a total of 7151 cardiopulmonary deaths in these cities and that a total of 492 of these were likely due to particulate air pollution.  This is equivalent to 6.8% of the cardiopulmonary mortality in these cities.  Thus, being conservative, this study assumes an EAFR for cardiovascular mortality from particulate air pollution of between 4-9% in Oregon. We use a best estimate of 6.5%, the median of the EAFR.   This EAF only considers mortality costs. It is likely that cardiovascular disease also has associated morbidity costs not accounted for in this estimate.

Costs in Oregon
This estimate of the costs of cardiovascular disease in Oregon attributable to environmental contaminants is based on the following assumptions:

• American Heart Association national estimate of $431.8 billion in 2007 dollars;
• Oregon constitutes 1.22% of the U.S. population;
• Direct health care costs constitute 65.6% of total costs;
• Indirect health care costs constitute 34.4% of total costs; and
• An EAF of 6.5% and a range of 4-9%.

Annual costs of cardiovascular disease in Oregon = $431.8 billion * 1.22% = $5.27 billion in 2007 dollars.

Applying the EAFs of 0.04, 0.065, and 0.09 yielded the following results:

• EAF 0.04 = $210,800,000
• EAF 0.065 = $342,550,000
• EAF 0.09 = $474,300,000
  

This cost estimate is very conservative since it only considers the mortality costs of cardiovascular disease due to particulate air pollution.

Using these assumptions, the best estimate of the annual costs of cardiovascular disease attributable to environmental contaminants in Oregon is $342.5 million in 2007 dollars (comprising an estimated $224.7 million in direct health care costs and $117.8 million in indirect costs), with a range of $210.8-474.3 million.

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