Calculation of the disease burden associated with environmental chemical exposures: application of toxicological information in health economic estimation

Table 2 Estimates of economic costs associated with air pollution

Adverse consequence	Context	Economic cost ($billions)	% GDP	% of Global GDP
Asthma	U.S. [57]	2.33 [0.728–2.5]	0.02 [0.006–0.021]	<0.01
	EU [82]	1.70 [0.568–1.98]	0.01 [0.003–0.012]	<0.01
	EU city children [97]	0.151 [0.03–0.3]^a	<0.01	<0.01
Preterm birth	U.S. [98]	4.3 [2.06–8.22]	<0.01	<0.01
Cardiovascular	EU [99]	37.24 [24.47–49.83]^a	0.22 [0.14–0.29]	0.06
All health impacts	OECD countries [100]	500 [300–1250]	1.2 [0.7–2.8]	0.8 [0.5–2]
	China [100]	483 [300–1200]	8 [5–20]	0.8 [0.5–2]
	India [100]	120 [74–300]	7 [4–17]	0.2 [0.1–5]
	Sum (OECD, China, India)	1100 [700–2760]	2.2 [1.3–5.4]	1.8 [1.1–4.4]
	World (WHO) [52]	1177 [736–2942]	1.9 [1.1–4.6]	1.9 [1.1–4.6]
	World (GBD) [3]	1083 [677–2709]	1.7 [1.1–4.3]	1.7 [1.1–4.3]

Base case estimates are presented along with range [low/high end estimates] from sensitivity analysis or 95 CI^a. All estimates are given in $2010, a 1.33 rate change € /$ is used, and for estimates prior to 2010, inflated adjustments are made. OECD estimates are based on DALYs reported for OECD countries (High Income Countries, HICs), China (Upper Middle Income Country, UMIC), & India (Lower Middle Income Country, LMIC). Our estimates of DALYs for OECD, WHO and GBD are based on Value of Life Year (VOLY) [50] adjusted to $2010 PPP and for inflation and then adjusted per income group levels from World Bank GNI per capita in $ppp2010. For consistency we valued OECD DALY estimates based on VOLY instead of using Value of Statistical Life Year (VSL) for mortality costs (additional 10% for morbidity included) as reported in OECD [100]