Sylvia Brandt

Disparities in asthma hospitalization in Massachusetts

OBJECTIVES We examined racial disparities in asthma morbidity in Massachusetts. METHODS We used Massachusetts case-mix data from 1994 to 2002 to screen and track individual asthma morbidity and hospitalizations, which resulted in a sample of 10145 patients who were first hospitalized for asthma between 1997 and 2000. We followed these patients for 2 years after their first hospitalization. Because asthma is widely considered a preventable cause of hospitalization, we interpreted a readmission for asthma as an indication of failed asthma management. RESULTS We found substantial racial/ethnic disparities in readmission rates that persisted after control for comorbidities, payer type, and income. We estimated that the costs of repeat hospitalizations for asthma are in excess of one quarter of all asthma hospitalization costs. CONCLUSION Racial/ethnic disparities in asthma readmission rates show that Massachusetts is not on the frontier of asthma treatment.

Near-Roadway Pollution and Childhood Asthma: Implications for Developing “Win–Win” Compact Urban Development and Clean Vehicle Strategies

Background: The emerging consensus that exposure to near-roadway traffic-related pollution causes asthma has implications for compact urban development policies designed to reduce driving and greenhouse gases. Objectives: We estimated the current burden of childhood asthma-related disease attributable to near-roadway and regional air pollution in Los Angeles County (LAC) and the potential health impact of regional pollution reduction associated with changes in population along major traffic corridors. Methods: The burden of asthma attributable to the dual effects of near-roadway and regional air pollution was estimated, using nitrogen dioxide and ozone as markers of urban combustion-related and secondary oxidant pollution, respectively. We also estimated the impact of alternative scenarios that assumed a 20% reduction in regional pollution in combination with a 3.6% reduction or 3.6% increase in the proportion of the total population living near major roads, a proxy for near-roadway exposure. Results: We estimated that 27,100 cases of childhood asthma (8% of total) in LAC were at least partly attributable to pollution associated with residential location within 75 m of a major road. As a result, a substantial proportion of asthma-related morbidity is a consequence of near-roadway pollution, even if symptoms are triggered by other factors. Benefits resulting from a 20% regional pollution reduction varied markedly depending on the associated change in near-roadway proximity. Conclusions: Our findings suggest that there are large and previously unappreciated public health consequences of air pollution in LAC and probably in other metropolitan areas with dense traffic corridors. To maximize health benefits, compact urban development strategies should be coupled with policies to reduce near-roadway pollution exposure.

Costs of childhood asthma due to traffic-related pollution in two California communities

Recent research suggests the burden of childhood asthma that is attributable to air pollution has been underestimated in traditional risk assessments, and there are no estimates of these associated costs. We aimed to estimate the yearly childhood asthma-related costs attributable to air pollution for Riverside and Long Beach, CA, USA, including: 1) the indirect and direct costs of healthcare utilisation due to asthma exacerbations linked with traffic-related pollution (TRP); and 2) the costs of health care for asthma cases attributable to local TRP exposure. We calculated costs using estimates from peer-reviewed literature and the authors’ analysis of surveys (Medical Expenditure Panel Survey, California Health Interview Survey, National Household Travel Survey, and Health Care Utilization Project). A lower-bound estimate of the asthma burden attributable to air pollution was US

Evaluating tradable property rights for natural resources: The role of strategic entry and exit

18 million yearly. Asthma cases attributable to TRP exposure accounted for almost half of this cost. The cost of bronchitic episodes was a major proportion of both the annual cost of asthma cases attributable to TRP and of pollution-linked exacerbations. Traditional risk assessment methods underestimate both the burden of disease and cost of asthma associated with air pollution, and these costs are borne disproportionately by communities with higher than average TRP.

Time and risk preferences and the use of asthma controller medication.

This paper presents an econometric approach to the evaluation of environmental regulation using tradable property rights. Existing empirical research on this issue, which compares overall industry efficiency before and after the introduction of new regulations, conflates two distinct phenomena: efficiency changes due to exit of excess capital, and changes in the efficiency of individual firms. Because the regulatory process induces firms of different types to enter and exit the industry at different rates, the true efficiency and equity effects of tradable property rights cannot be assessed without correcting for these changes in sample composition. This paper examines the impact of regulatory change in the Mid-Atlantic surf clam fishery, using an econometric model that separates its effects on industry structure and vessel efficiency. The analysis finds that, contrary to widely held belief, tradable property rights did not disproportionately benefit either large fishing firms or highly integrated firms.

An analysis of predictors of sustainability efforts at the Inner-City Asthma Intervention sites: after the funding is gone

OBJECTIVES: We investigated the role of risk tolerance, time preference, and asthma-specific attitudes in adherence to asthma control medications. METHODS: Students with persistent asthma completed an online survey on asthma beliefs, risk tolerance, and time preference (n = 47). The time preference questions measure the degree to which the individual discounts future outcomes and essentially prefers immediate gratification to delayed gratification. The risk tolerance questions indicate the individual’s dislike of uncertainty about outcomes. We analyzed the relationship between the independent and dependent variables. RESULTS: Feelings of embarrassment and concern about medication, as well as risk tolerance and time preference, were found to be significant predictors of adherence to control medication in the logistic regression. Analysis of probabilities associated with different profiles shows that at high rates of risk tolerance and discounting of future outcomes, the probability of adherence is near 0 regardless of asthma-specific attitudes. Asthma attitudes have a statistically significant effect for individuals with low rates of risk tolerance and time preference. CONCLUSIONS: The risk tolerance and time preferences of the target group should be considered when designing an asthma-intervention program. Individuals who strongly prefer immediate gratification over future benefits and are willing to tolerate uncertain outcomes are unlikely to adhere to controller medication, regardless of their asthma attitudes. In contrast, efforts to affect relevant attitudes will be most fruitful for individuals with low rates of risk tolerance and time preference. However, as we cannot extrapolate these results to a larger population, we must view them with caution.

Cost of near-roadway and regional air pollution-attributable childhood asthma in Los Angeles County.

BACKGROUND The Inner-City Asthma Intervention was a national, multicenter implementation of an evidence-based intervention to reduce asthma morbidity in inner-city children that was funded by the Centers for Disease Control and Prevention. Funding was initially planned for 4 years beginning in April 2001, but because of budgetary changes funding ceased in September 2004, 6 months before the original plan. Some sites were able to sustain their asthma program when the funding ended and others were not. OBJECTIVE To compare characteristics of sites that were able to sustain their asthma program after the original funding ended with those that were not. METHODS Data were collected from the project manager at each site in an electronic survey and through telephone interview in November 2003 and August 2005. Using contingency tables, we examined the bivariate relationship between each proposed factor and our outcome measure, secured funding. RESULTS Of the 18 sites that completed the survey, 50% reported continued funding. All sustainable sites received funding from multiple sources, including either the hospital or the community. One site received federal funding and one site received state funding. Of the sites that presented data to multiple funders, 6 of 9 were sustained (P = .05). CONCLUSIONS Sustainable programs were more likely to be funded locally. Programs that used an evaluative process, including patient outcomes data, to demonstrate the importance of the program to their institution and community were more likely to obtain continued funding compared with those that did not.

The Effects of ITQ Management on Fishermen’s Welfare When the Processing Sector is Imperfectly Competitive

BACKGROUND Emerging evidence suggests that near-roadway air pollution (NRP) exposure causes childhood asthma. The associated costs are not well documented. OBJECTIVE We estimated the cost of childhood asthma attributable to residential NRP exposure and regional ozone (O3) and nitrogen dioxide (NO2) levels in Los Angeles County. We developed a novel approach to apportion the costs between these exposures under different pollution scenarios. METHODS We integrated results from a study of willingness to pay to reduce the burden of asthma with results from studies of health care use and charges to estimate the costs of an asthma case and exacerbation. We applied those costs to the number of asthma cases and exacerbations caused by regional pollution in 2007 and to hypothetical scenarios of a 20% reduction in regional pollution in combination with a 20% reduction or increase in the proportion of the total population living within 75 m of a major roadway. RESULTS Cost of air pollution-related asthma in Los Angeles County in 2007 was

Near-Roadway Air Pollution and Coronary Heart Disease: Burden of Disease and Potential Impact of a Greenhouse Gas Reduction Strategy in Southern California.

441 million for O3 and

Examining Household Asthma Management Behavior Through a Microeconomic Framework

202 million for NO2 in 2010 dollars. Cost of routine care (care in absence of exacerbation) accounted for 18% of the combined NRP and O3 cost and 39% of the combined NRP and NO2 cost; these costs were not recognized in previous analyses. NRP-attributable asthma accounted for 43% (O3) to 51% (NO2) of the total annual cost of exacerbations and routine care associated with pollution. Hypothetical scenarios showed that costs from increased NRP exposure might offset savings from reduced regional pollution. CONCLUSIONS Our model disaggregates the costs of regional pollution and NRP exposure and illustrates how they might vary under alternative exposure scenarios. The cost of air pollution is a substantial burden on families and an economic loss for society.