AJ Hedley PYK Chau SM McGhee KWY Chung HK Lai CQ … · J Chau1 1. Department of ... Macao and Hong Kong based on diﬀerencesbetween ... Appendix 2 Summary on health care costs due

1Report on Air Quality and the State of Public Health in Southern China

Department of Community MedicineSchool of Public HealthThe University of Hong Kong

AJ Hedley1

SM McGhee1 HK Lai1

J Chau1

1. Department of Community Medicine, School of Public Health, The University of Hong Kong2. Guangzhou No.12 Hospital

PYK Chau1 KWY Chung1 CQ Jiang2

CM Wong1

This study was commissioned by Civic Exchange and funded by the Rockefeller Brothers Foundation


Addresses for correspondence

Department of Community Medicine,

School of Public Health,

University of Hong Kong Faculty of Medicine

5/F William M.K. Mong Block

21 Sassoon Road,

Hong Kong Tel: (852) 2819 9280

Fax:(852) 2855 9528

http://www.hku.hk/cmd/

[email protected]

[email protected]

[email protected]

[email protected]

[email protected]

Acknowledgements

The authors would like to thank the following organizations/ people in support of producing this report:

• Civic Exchange

• Rockefeller Brothers Foundation for their funding support of the project

• Hospital Authority for providing public hospitalisation data

• Dr. Li Fang of the Women and Children’s Hospital in Guangzhou for advice on collecting data for the Pearl

River Delta


Table of Contents

Page No.

Abbreviation list 6

1. Background 7

2. Objectives 7

3. Data and methods 8

3.1. Overview

3.2. Air pollutant data

3.3. Excess risks

3.4. The annual cost of respiratory and cardiovascular diseases

3.5. The attributable cost of health care due to air pollution

3.6. Combining the effects of four air pollutants

4. Validation 20

4.1. Total cost based on estimates of PM10

derived from satellite remote-sensing

4.2. Unit health care cost between the PRD and HK

4.3. Estimating utilisation

5. Findings 22

5.1. Annual attributable deaths, bed-days, doctor visits

5.2. Direct health care costs

5.3. Indirect health care costs

5.4. Sum of health care costs

5.5. Comparison of costs between PRD and HK

5.6 Total cost based on estimates of PM10

derived from satellite remote-sensing

6. Sensitivity Analyses 24

6.1. Total cost based on simple summation of the effect of all 4 pollutants

6.2. Total cost based on other methods of adjusting the summation of the effect

of all 4 criteria pollutants

6.3. Direct and indirect health care cost based on different estimations of health

care utilization and costs data

6.4. Total cost based on mean income and median income in HK and MSAR

7. Discussion 25

References 30


List of Tables

Table 3.1 Excess risks (%) per 10 µg/m3 change of different air pollutants 10

Table 3.2 Parameter list for direct and indirect health care cost in Pearl

River Delta (PRD)

35

Table 3.3 Parameter list for direct and indirect health care cost in MSAR

(M)

37

Table 3.4 Parameter list for direct and indirect health care cost in Hong

Kong (HK)

40

Table 3.5 Parameter list for comparison between 9 prefectures in Pearl

River Delta (PRD) and Hong Kong (HK)

43

Table 3.6 List of assumptions adopted in the study 45

Table 4.1 Total cost due to PM10

concentrations from 9 monitoring stations

in PRD and satellite remote sensing

48

Table 5.1 Estimated attributable deaths, hospital bed days and outpatient

visits in PRD and MSAR for 2006 pollution levels

49

Table 5.2 Estimated attributable deaths, hospital bed days and outpatient

visits in Hong Kong, three estimates

51

Table 5.3 Annual direct, indirect and total health care costs for Air Pollution

in the PRD, Macao and Hong Kong based on differences between

average 2006 and WHO guidelines/US EPA standard air pollutant

levels

52

Table 5.4 Costs per one million population for air pollution in the PRD,

Macao, and Hong Kong based on differences between average

2006 and WHO guidelines/US EPA standard air pollutant levels

53

Table 6.1 Sensitivity analysis on combination of 4 air pollutants 54

Table 6.2 Sensitivity analysis on WHO guideline values 56

Table 6.3 Sensitivity analysis on effects of PRD air data on the HK model 57

Table 6.4 Sensitivity analysis on total numbers of bed-days in private hos-

pitals in PRD

57

Table 6.5 Sensitivity analysis on proportion of hospital inpatients for each

disease in PRD

58

Table 6.6 Sensitivity analysis on average cost per bed-day in public hospi-

tals

58

Table 6.7 Sensitivity analysis on average cost of an inpatient episode in

Shenzhen

59

Table 6.8 Sensitivity analysis on number of hospital inpatients for employed

population

59

Table 6.9 Sensitivity analysis on mean and median monthly income in HK

and MSAR

59


List of Figures

Figure 3.1 Thirteen air pollution monitoring stations in Guangdong Prov-

ince, three monitoring stations in HKSAR in PRDRAQmn, and two

monitoring stations in MSAR.

9

Figure 3.2 Monthly average air pollution levels averaged from 9 monitoring

stations in Guangdong 10 in Hong Kong and 2 in MSAR

10

Figure 3.3 Method for combining pollutant effects based on correlation

between PM10

, NO2 and SO

2 at monitoring stations

21

Figure 5.1 Total monthly costs due to 4 air pollutants in PRD, MSAR and HK

in 2004

23

Appendices

Appendix 1 Detailed tables on direct and indirect health care cost due to air

pollution

61

Appendix 2 Summary on health care costs due to air pollution including

malignant neoplasms

83

Appendix 3 Proxy geographic locations of 9 monitoring stations for sensitivity

analysis based on satellite remote sensing information.

88

Appendix 4 Surrounding appearance of the monitoring stations in Jiangmen,

Shenzhen, Zhongshan, and Zhuhai.

89

Appendix 5 Annual average concentration (in µg/m3) of each pollutant in nine

prefectures of Pearl River Delta, MSAR and Hong Kong

90


Abbreviation list

A&E Accident and Emergency

AOD Aerosol optical depth

API Air Pollution Index

DG Dongguan

EPD Environmental Protection Department

FS Foshan

GDP Gross Domestic Product

GOPC General Outpatient Clinics

GP General Practitioners

GZ Guangzhou

HA Hospital Authority

HK Hong Kong

HZ Huizhou

ICD-9 International Classification of Disease, Revision 9

JM Jiangmen

LOS

M

MSAR

Lengths of stay

MSAR

MSAR Special Administrative Region

NO2

Nitrogen dioxide

O3

Ozone

PM10

Particulate matters with aerodynamic diameter smaller than 10µm

PRD Pearl River Delta

PRDRAQmn Pearl River Delta Regional Air Quality Monitoring Network

PYLL Person-years of life lost

RSP Respirable suspended particulates (or PM10

)

SAR Special Administrative Region

SO2

Sulphur dioxide

SOPC Specialty Outpatient Clinics

SZ Shenzhen

WHO World Health Organisation

ZH Zhuhai

ZQ Zhaoqing

ZS Zhongshan


1. Background

Hong Kong (HK) is an island with many outlying islands in the South China Sea. Its subtropical weather brings abun-

dant rainfall and tropical cyclones in the summer season. The land is mainly covered by hills and mountains in an area

of 1092 km2. The population is about 6.9 million with GNP of HK$215,456 per capita in 2006.

Pearl River Delta (PRD) is a part of Guangdong (GD) Province which consists of nine prefectures and two Special

Administrative Regions (SARs). Those prefectures are Guangzhou (GZ), Shenzhen (SZ), Zhuhai (ZH), Dongguan (DG),

Zhongshan (ZS), Foshan (FS), Huizhou (HZ), Jiangmen (JM), Zhaoqing (ZQ) and the two SARs are Hong Kong (HK) and

MSAR (MSAR). PRD is closely connected to HK in terms of geographic areas, industrial development, communications

and transport and even ambient air quality. The number of motor vehicles transporting goods passing through Sha

Tau Kok or Lok Ma Chau (from Mainland China to HK) has increased by 35% since 1983 (Census and Statistics Depart-

ment 1984-2005). Energy production and consumption in Guangdong has increased by 382% and 253% respectively

from 1990 to 2004, and both continue to increase by about 20% each year (Bureau of Health of Guangdong Munici-

pality 2007).

MSAR, a part of China’s territory, is located in the PRD on the southeastern coast of Mainland China. The territory, with

an area of 28.6 km2, comprises the MSAR Peninsula, Taipa Island, Coloane Island and the reclaimed area Cotai. MSAR

has developed industries such as textiles, electronics and toys, as well as having built up a world class tourist industry

with wide choices of hotels, sports facilities, restaurants and casinos. MSAR's economy is closely linked to that of HK

and Guangdong province. It provides support to financial and banking services, staff training, transport and commu-

nications (MSAR Government Tourist Office website, 2008).

Air pollution has created a new disease burden on our health and health care system. In 2002, the short term health

impact and costs due to air pollution were reported by the Department of Community Medicine, University of Hong

Kong (Environmental Protection Department, 2002). Some studies have demonstrated that trans-boundary air pol-

lution problems should be assessed in terms of the spatial influences and sources of major emission (Mukerjee et al

2001; Watson and Chow 2001; Smith et al 2001 and Mukerjee 2002). Evaluating the air quality in Southern China and

its impact on health and health care costs is seen as an essential step in assessing the effectiveness of air pollution

control policies in the region.

This report describes the development of a model for estimating the health burden due to air pollution in PRD by

incorporating health effect estimates (i.e. the excess risks) from daily time-series studies of air pollution and estimat-

ing the avoidable impact of air pollution, in terms of health care utilization, deaths and the community costs, for

exceedances of the WHO guideline values and US EPA standards.

2. Objectives

The objectives of the project are:

• To estimate the direct costs of health care utilization due to air pollution attributable diseases in PRD including

MSAR and HK

• To estimate the indirect costs of health care utilization due to air pollution in these communities

• To compare the health care costs between PRD, MSAR and HK.


3. Data and methods

3.1 Overview

We developed a model for estimating the health burden due to air pollution using health care and mortality data

from PRD together with measurements of air pollutants from these regions in 2006 and incorporating health effect

estimates (i.e. the excess risks) from daily time-series air pollution studies conducted in HK. The previous model for HK

was also re-worked to make it directly comparable with the PRD model.

We incorporated into the model the monthly average pollutant concentrations for HK, MSAR and the nine Guang-

dong prefectures thus creating 11 specific costing models. The following is a summary of the procedures we used:

• We searched for the relevant data for Guangdong, the nine prefectures in the PRD area and MSAR, including

demographic profiles, mortality rates, hospital admissions and outpatient visits in the public and private sectors,

self care data, productivity loss data and costs data through the internet as well as from sources of expert advice

(personal communications with Dr. Jiang and Dr. Li).

• We estimated the annual burden of air pollution attributable diseases, including direct health care costs and

productivity losses due to hospital admissions and premature deaths.

• We included two main categories of diseases, cardiovascular diseases and respiratory diseases, attributable to

air pollution. We also included malignant neoplasms as an additional analysis for the models on the nine pre-

fectures and HK (see appendix 2) but not for the MSAR model since there was no data available on malignant

neoplasms alone in MSAR.

• We applied the monthly average values in exceedance of both the WHO guideline values and the US EPA stand-

ards and resulting excess risks for four air pollutants (NO2, SO

2, RSP, O

3) which were then applied to the total

annual burden of diseases to estimate the burden of disease attributable to exceedance of the air pollution

guidelines.

• We the estimated the excess costs of health care utilisation and productivity losses attributable to each of the

four air pollutants and total annual air pollution pattern for the 11 geographic areas.

• We performed a wide range of sensitivity analyses to take account of uncertainties in the estimates of the air

pollutant, health care utilisation and cost data.

3.2 Air pollutant data

In our cost estimation, we used the individual stations for each prefecture to present different population exposures

that varied spatially across PRD region. Prefecture-specific analyses of the cost of health burden were based on the

following air pollution data in each PRD prefecture, MSAR and HK.

PRD: In Guangdong Province, four air pollutants including respirable suspended particulates (PM10

), nitrogen

dioxide (NO2), sulphur dioxide (SO

2), and ozone (O

3), are measured by the Pearl River Delta Regional Air Quality

Monitoring Network (PRDRAQmn), which was jointly established by the Guangdong Provincial Environmental

Protection Monitoring Centre and the Environmental Protection Department of Hong Kong Special Adminis-


trative Region (HKSAR). It came into operation on 30 November 2005. Currently, daily data from the Mainland

monitoring stations are not available in the PRDRAQmn but monthly average values can be obtained from their

annual report (PRDRAQmn 2006). All estimation of this study is based on the 2006 monitoring results from

PRDRAQmn.

PRDRAQmn comprises 16 monitoring stations: 13 stations located in 9 prefectures of the Guangdong Province

and 3 stations located in the HKSAR (Figure 3.1). We selected one station in each prefecture as representative.

Among the 13 stations in the Mainland, 4 stations were not included in this study (Figure 3.1), namely Tianhu,

Luhu, Jinguowan and Shunde Dangxiao stations. The average of the monthly average data from these stations

was used to represent the province-wide monthly estimates (Figure 3.2).

MSAR: For MSAR, we used the monthly average values of 2 monitoring stations from Direcção dos Serviços Mete-

orológicos e Geofísicos (the meteorological office in MSAR), including High density Resident (Macao) station and

Ambient station (MSAR Air Quality Index website, 2008). The other two stations in MSAR, High density Resident

(Taipa) station and Roadside station were excluded due to incomplete data for all four pollutants and the road-

side type. The average of the monthly data from the two selected stations represented the city-wide monthly

estimates (Figure 3.2).

HK: For HK, instead of using the data from the three monitoring stations in the PRDRAQmn annual report, we

used the monthly average values of 10 general monitoring stations from the Environmental Protection Depart-

ment’s annual report (Air Science Group, Environmental Protection Department, 2006). These 10 monitoring

stations are located neither by the roadside nor in the countryside and the stations in Causeway Bay, Central,

Mongkok, and Tap Mun were excluded. The average of the monthly data from these stations represented city-

wide monthly estimates (Figure 3.2).

Figure 3.1: Thirteen air pollution monitoring stations in Guangdong Province, three monitoring stations in HKSAR in PRDRAQ, and two

monitoring stations in MSAR. Five PRDRAQmn stations (x) are excluded from this study.

City Monitoring Station

Regional Monitoring Station


Figure 3.2: Monthly average air pollution levels from 9 monitoring stations in Pearl River Delta (PRD), 10 in Hong Kong (HK) and 2 in MSAR (M)

3.3 Excess risks

The excess risks per 10 µg/m3 change in each pollutant (PM10

, NO2, SO

2 and O

3) for all natural causes of mortality (ICD-

9 001-799), hospitalization of patients with cardiovascular diseases (ICD-9 390-459) and respiratory diseases (ICD-9

460-519) and general practice consultations with respiratory diseases were derived from daily time-series studies

(Table 3.1).

Table 3.1: Excess risks (%) [95% C.I.] per 10 µg/m3 change of different air pollutants

PM10

NO2

SO2

O3

Mortality*:

All natural causes 0.24 [0.01, 0.46] 0.64 [0.36, 0.91] 1.36 [0.93, 1.78] -0.11 [-0.37, 0.16]

Hospitalisation*:

Cardiovascular diseases 0.37 [0.18, 0.57] 0.73 [0.48, 0.98] 1.08 [0.72, 1.44] 0.24 [0.01, 0.47]

Respiratory diseases 0.50 [0.28, 0.71] 0.54 [0.27, 0.80] 0.76 [0.34, 1.18] 0.55 [0.31, 0.79]

Private hospital outpatient/

Private General Practitioners†:

Respiratory diseases 3.28 [2.52, 4.05] 3.42 [-0.62, 7.63] 0.68 [-3.03, 4.54] 1.50 [-1.18, 4.26]

Note: * derived from Wong CM et al 2002; †derived from Wong TW et al 2002.


3.4 The annual cost of respiratory and cardiovascular diseases

The attributable cost of disease due to air pollution was estimated by applying the excess risks to the annual burden

of disease and its monetary value to obtain the attributable health-related costs for air pollution in each prefecture,

MSAR and HK. The health costs include deaths, inpatient hospitalisations and outpatient consultations. The magni-

tude of these costs indicate the loss to quality of life and pain and suffering related to air pollution but the full value of

these intangible costs is not reflected in the monetary costs presented. These health costs were calculated by apply-

ing the excess risks to the total numbers of deaths, hospital bed-days and outpatient visits to obtain the attributable

costs. The remainder of this section describes how the attributable health care utilisation and productivity losses

were estimated and valued in order to identify the minimum financial loss to the population through paying for extra

health care due to air pollution.

The monetary costs comprised two components: the direct and indirect health care costs. The direct health care

costs were the cost of illnesses and the indirect costs were the productivity losses due to hospital admissions

and premature deaths. Tables 3.2, 3.3 and 3.4 show the parameters used in calculating the direct and indirect

health care costs. All costs were based on or adjusted to the year 2004. Table 3.6 shows the list of assumptions

adopted in this study.

3.4.1 Cost of illness

PRD: The direct health care costs due to two main groups of diseases, cardiovascular and respiratory diseases,

were estimated for year 2004 for the nine prefectures in PRD. The classifications of disease categories were made

by the Bureau of Health of Guangzhou Municipality. Inpatient and outpatient costs in the public and private hos-

pitals were included in the calculation of direct health care costs in the PRD. The outpatient costs were calculated

as number of outpatient visits multiplied by the unit cost of a visit. The unit cost included the costs of operating

and staffing the premises, registration, drugs, investigations and treatment. Similarly, the inpatient costs were cal-

culated as the number of episodes multiplied by the average number of bed-days in an episode and the average

bed-day cost. The bed-day cost included the “hotel” costs, (bed, food, cleaning, electricity etc), and the cost of hos-

pital staff, drugs, investigations and treatment.

MSAR: The health care costs due to respiratory and cardiovascular diseases in MSAR were estimated for

2004 in a similar way. The classifications of disease categories were made by the Department of Health,

Government of the MSAR. Only two hospitals, S. Januario Hospital (a public hospital) and Kiang Wu Hospi-

tal (a private hospital) were considered in the model since the third hospital in MSAR, MSAR University of

Science and Technology Hospital, provides Chinese medicine. Episodes in the public and private hospitals,

visits to emergency services (A&E) in public and private hospitals, to public and private hospital out-patient

departments, to public health care centres, to other establishments providing health care under the public

and private sectors, to private clinics and to private centres for auxiliary diagnostic examinations were

included in the calculation of direct health care costs in MSAR. The computation methods and the assump-

tions used are specified in the next section.

HK: The health care costs due to respiratory and cardiovascular diseases in Hong Kong in 2004 were estimated in

a similar way to compare these with the output of the models for the nine prefectures. The classifications of dis-

ease categories were made by ICD-9. Episodes in public and private hospitals, visits to accident and emergency

departments (A&E), to specialist (SOPC) and general outpatient clinics (GOPC) and to private general practition-

ers (GP) were included in the calculation of direct health care costs in Hong Kong. The computation methods


and the assumptions used are specified below.

3.4.1.1 Public hospitals inpatients

For all the PRD, MSAR and Hong Kong models, the cost per inpatient episode was calculated by multiplying the

average cost per bed-day with the mean number of bed-days in an episode - the length of stay (LOS). The annual

cost of public hospital episodes was calculated by multiplying the cost per inpatient episode by the annual

number of episodes.

Cost per inpatient episode

Mean length of stay (LOS) per episode

PRD: The mean LOS for episodes due to the two main diseases were obtained from the Guangzhou (GZ) Health

Statistical yearbook (廣州市衛生局, 2004) but we had no data on LOS for the other prefectures except Shen-

zhen. We assumed that the GZ LOS applied to all prefectures in the PRD. We used the data on LOS for Shenzhen

in the sensitivity analysis (Table 6.7)

MSAR: Mean LOS due to the two main diseases were obtained from the Department of Health Statistical year-

book 2004 (Department of Health, Government of MSAR). There were no separate figures for males and females

and therefore the overall mean LOS was used.

HK: Mean LOS due to the two main diseases in acute general and chronic infirmary hospitals for males and females

were obtained from the HA inpatient database for the year 2002 and assumed to apply to 2004.

Average costs per bed-day

PRD: Average costs per bed-day in non-profit general hospitals in all prefectures of PRD were obtained (廣東衛

生信息網 2003; 佛山市衛生信息網 2005; 中山市衛生局 2004) and assumed to be the same for all public hos-

pitals and for all diseases. The average costs per bed-day in each prefecture in 2003 were adjusted to 2004 prices

using the Guangdong prices as a guide to the inflation rate.

MSAR: Average costs per bed-day in the public hospital in MSAR were not available. We assumed the costs were

the same as that of Hong Kong acute general hospitals since the mean LOS for the two diseases in MSAR were

comparable to those in Hong Kong.

HK: Average costs per bed-day in acute general and chronic infirmary hospitals in Hong Kong for the year 2000

were obtained from the HA (Hospital Authority, 2000) and were assumed to be the same for both genders and

for the two main diseases. These were adjusted by the deflation rate to 2004 prices (Census and Statistics Depart-

ment, 2005).

Number of inpatient episodes per year

PRD: The annual numbers of inpatient episodes for all diseases in four prefectures (GZ, ZH, ZS, FS) and GD prov-

ince were obtained (廣州市衛生局, 2004; 珠海市統計信息網 2006; 中山市衛生局 2004; 佛山市衛生信息網

2005; 廣東衛生信息網 2003) in 2004.

The annual episodes for all diseases in the other five prefectures within GD province were estimated by multiply-


ing the number of episodes in GD by the proportion of the GD population in each prefecture.

The proportion of all inpatient episodes which were attributable to the two main diseases in all eight prefectures

was taken to be the same as that reported for Guangzhou public inpatient episodes (廣州市衛生局, 2004).

MSAR: The annual numbers of inpatient episodes in S. Januario Hospital for the two main diseases were obtained

from the Department of Health Statistical yearbook 2004 (Department of Health, Government of MSAR).

HK: The annual numbers of inpatient episodes in Hong Kong for the two main diseases, in males and females

and in acute general and chronic infirmary hospitals were obtained from the Hospital Authority (HA) clinical

database for the year 2002 and were assumed to apply also to 2004.

3.4.1.2 Private hospitals inpatients

PRD: The annual episodes for all diseases in the nine prefectures were estimated by multiplying the number of

private hospital episodes in GD (廣東衛生信息網 2003) by the proportion of the GD population in each prefec-

ture. The cost was estimated in the same way as for public hospital costs using the numbers of private hospital

episodes in each prefecture and assuming that the other parameters (LOS and bed-day cost) were the same as

in public hospitals.

MSAR: The annual episodes for Kiang Wu Hospital were estimated by deducting the annual inpatient episodes

for S. Januario Hospital (Department of Health, Government of Macau) from the total annual in-patient episodes

for the two hospitals, S. Januario Hospital and Kiang Wu Hospital (Statistics and Census Service, 2005a). The cost

was estimated in the same way as for public hospital costs using the numbers of private hospital episodes and

assuming that the other parameters (LOS and bed-day cost) were the same as in public hospitals.

HK: The relative proportion of total annual bed-days in public and private sectors in HK was obtained from the

Hospital Authority Annual Report (Hong Kong Hospital Authority 2001) and used to calculate the number of

bed-days in private hospitals as below:

Total number of bed-days in public hospitals * (Proportion of the number of bed-days in private sector /

Proportion of the number of bed-days in public sector)

These 2001 data were assumed to apply to 2004. All other parameters were assumed to be the same as for

public acute hospitals.

3.4.1.3 Public hospital outpatients (PRD), public hospital outpatients and other outpatient visits (MSAR) and public outpatient visits (HK)

Cost per outpatient visit

PRD: The average costs per outpatient visit in non-profit general hospitals were obtained for the year 2003

for the nine prefectures in the PRD (廣東衛生信息網 2003). The average costs per visit included hospital

outpatient visits and A&E visits and were assumed to be the same for cardiovascular and respiratory dis-

eases. They were adjusted to 2004 prices using Guangdong prices (中華人民公和國國家統計局, 2005) as a

guide to the inflation rate.


MSAR: The average costs per outpatient visit in the public hospital (S. Januario Hospital), public health

care centres and other public establishments providing health care were not available. We assumed that

they would be the same as those in HK. Since there were no separate utilization figures for general and

specialist clinic visits in MSAR, the average of the costs per GOPC and SOPC visits in HK was used. The

average costs per A&E visit in S. Januario Hospital were also not available and assumed to be the same as

that in HK.

HK: Public outpatient costs included attendances to GOPC, SOPC and A&E clinics. The cost per visit in the GOPC in

2000 was obtained from the HA (Hong Kong Hospital Authority 2002) and the Department of Health (Health and

Welfare Bureau 2000). The cost per visit in SOPC in 2000 was obtained from the HA and was applied to all visits

in Medicine and Surgery clinics. The average cost per visit in A&E in 2000 was obtained from the HA (HA costing

exercise 2000). The above costs per visit were assumed to be the same for the two diseases and for both males and

females and were adjusted by deflation to 2004 prices.

Number of visits per year

PRD: The annual numbers of outpatient visits in three prefectures (GZ, ZS, FS) and GD province were obtained

(廣州市衛生局, 2004; 中山市衛生局 2004, 佛山市衛生信息網 2005, 廣東衛生信息網 2005). The proportions

of the number of visits due to the two diseases were assumed to be the same as for inpatient episodes in GZ.

The annual numbers of visits in the other six prefectures were estimated in the same way as described in section

3.3.1.1 (number of episodes per year) above.

MSAR: The annual numbers of outpatient visits in the public hospital (S. Januario Hospital) due to the two

diseases were obtained from the Department of Health Statistical yearbook 2004 (Department of Health,

Government of MSAR). The annual numbers of outpatient visits in public health care centres and other public

establishments providing health care were estimated based on the Health Care Survey in 2004 (Statistics

and Census Service, 2005a), where it provided data on the number of consultations of primary health care

by specialty including the two main diseases and proportions of health care establishments of public and

private sectors. The proportion of health care establishments in the public sector (3.2%) was applied to the

numbers of consultations for the two main diseases. The total annual number of outpatient visits in the A&E

department in S. Januario Hospital was obtained from the Department of Health Statistical yearbook 2004

(Department of Health, Government of MSAR). The proportions of the A&E visits due to the two main disease

groups were assumed to be the same as for inpatient episodes in the hospital.

HK: The total numbers of A&E, SOPC (in the Department of Medicine and Surgery under the HA) and GOPC visits

(under the Department of Health and the HA) in year 2004 was obtained from the Census and Statistics Depart-

ment in Hong Kong (Census and Statistics 2005). The proportions of the visits due to the two main disease

groups were assumed to be the same as for HA inpatient episodes.

3.4.1.4 Private hospital outpatient (PRD), private hospital outpatients and other outpatient visits (MSAR) and private general practitioner visits (HK)

Average cost per visit

PRD: The average costs per outpatient visit in the private hospitals in the nine prefectures were not avail-

able and therefore they were assumed to be the same as those for non-profit general hospitals in the


relevant prefectures.

MSAR: The average costs per outpatient visit in the A&E department in Kiang Wu Hospital were not available and

assumed to be the same as that in HK. The average costs per outpatient visit in other private clinics, private centres for

auxiliary diagnostic examinations and other private establishments providing health care were also not available and

assumed to be the same as the mean consultation fee for a visit to a private general practitioner (GP) in HK.

HK: The mean consultation fee for a visit to a private GP was obtained from the Harvard Household Survey car-

ried out in 1998 (McGhee et al., 1998). It was adjusted to 2004 prices and assumed to be the same for all visits.

Number of visits per year

PRD: The annual numbers of private hospital outpatient visits for all diseases in Guangdong province in 2003 were

obtained (廣東衛生信息網 2003) and assumed to apply to 2004. The annual numbers of visits for all diseases in the

nine prefectures within GD province were estimated by multiplying the numbers of visits in GD by the proportion

of the GD population in each prefecture. We assumed that the proportions of diseases (inpatients and outpatients)

in the 8 prefectures were the same as for GZ inpatient episodes.

MSAR: The total annual number of outpatient visits in the A&E department in Kiang Wu Hospital was estimated by

deducting the annual number of outpatient visits in the A&E department in S. Januario Hospital (Department of

Health, Government of Macau) from the total annual number of visits to all emergency services (Statistics and Census

Service, 2005a). The proportions of the A&E visits due to the two main disease groups were assumed to be the same as

for inpatient episodes in the hospital. The total annual number of outpatient visits in other clinics, centres for auxiliary

diagnostic examinations and other establishments providing health care in the private sector was estimated from

the Health Care Survey in 2004 (Statistics and Census Service, 2005a), which provided data on the annual number of

consultations of primary health care for respiratory diseases and the proportion of primary health care establishments

in the private sector (96.8%).

HK: The proportion of respondents making a GP visits due to cold, flu or fever in the past two weeks and the

average number of visits were obtained from the 6134 respondents in the Harvard Household Survey (McGhee

SM et al 1998). These were applied to the HK population in 2004 and used to estimate the annual number of GP

visits due to respiratory diseases.

3.4.2 Productivity losses

The attributable productivity losses due to morbidity and premature mortality due to air pollution were estimated as the indirect

health care costs. We included losses due to attributable inpatient episodes for the two main diseases and due to attributable

deaths for any cause. These losses applied only to the working population aged from 15 to 64 years old.

The productivity losses due to attendance at public and private hospital outpatient clinics were not calculated for the nine

prefectures, MSAR or HK as there were no official data or related data on time off work for outpatient visits in the PRD.

3.4.2.1 Productivity loss due to inpatient episodes

The costs of productivity loss due to inpatient episodes were estimated for public and private hospitals. Productivity

losses for the duration of episodes were calculated by multiplying the mean LOS for each of the two main diseases by

the annual number of episodes for the working population for each disease and by an estimated daily income derived

from the reported mean yearly income for PRD (Statistics Bureau of Guangdong Province 2005) or a calculated mean


yearly income for MSAR and Hong Kong.

Mean LOS

PRD: The mean LOS in public and private hospitals in the PRD for those aged 15 to 64 were taken to be the same

as for all ages and calculated as described in sections 3.3.1.1 (cost per inpatient episode) and 3.3.1.2 above.

MSAR: The mean LOS in public and private hospitals in MSAR for those aged 15 to 64 to be the same as for all ages

and calculated as described in sections 3.3.1.1 (cost per inpatient episode) and 3.3.1.2 above.

HK: The mean LOS for those aged 15 to 64 in acute general and chronic infirmary hospitals in Hong Kong for the

two main diseases, in males and females were obtained from the HA clinical database for the year 2002 and were

assumed to apply also to 2004.

Annual number of episodes

PRD: The annual numbers of public and private hospital episodes for the two main diseases for those aged 15

to 64 we also assumed to be the same as for all ages and calculated as in sections 3.3.1.1 (number of episodes per

year) and 3.3.1.2 (number of episodes per year) above.

The proportions of the population aged 15 to 64 in seven prefectures, but not DG and JM, were obtained (中

山市統計局 2005b; 佛山市統計局 2005a; 廣州市統計局 2005b; 惠州市統計局 2005b; 深圳市統計局 2005;

珠海市統計局 2005b; 肇慶市統計局 2005b). For DG and JM, the proportion of this age group in Guangdong

province was used instead (廣東統計信息網 2005).

The registered urban unemployment rates in the nine prefectures were obtained from the government official

website or the Bureau of Statistics in each prefecture.

The annual numbers of inpatient episodes for employed people due to the two main diseases were obtained by

multiplying the annual numbers of hospital episodes for all ages by the proportion of the population aged 15 to

64 and by the reciprocal of the urban unemployment rate in 2004.

MSAR: The annual numbers of public and private hospital episodes for the two main diseases for those aged

15 to 64 were estimated by applying the proportion of all discharge episodes in S. Januario Hospital aged 15

to 64 as derived from the Department of Health Statistical yearbook 2004 (Department of Health, Govern-

ment of MSAR) to the total annual numbers of episodes for the two main diseases (Department of Health,

Government of MSAR). These figures were then multiplied by the labour force rate (Statistics and Census

Service, 2005b and 2007a) and the employment rate in the year 2004 obtained from the Employment Survey

2004 (Statistics and Census Service, 2005b).

HK: The number of inpatient episodes for the group aged 15 to 64 was obtained from the HA clinical database

in the year 2002. It was then multiplied by the labour force rate and the employment rate in the year 2004

obtained from the Women and Men in Hong Kong Key Statistics (Census and Statistics Department 2007).

Mean annual income

PRD: The mean annual income of workers in the nine prefectures in 2004 was obtained from the Guangdong

Statistical Yearbook (Bureau of Health of Guangzhou Municipality 2005).


MSAR: The mean monthly income of 219,143 employed persons in MSAR by gender was estimated by using

the middle values of sixteen monthly income categories and the number of employed persons in each category

obtained from the Employment Survey 2004 (Statistics and Census Service, 2005b). In estimating the mean

monthly income for employed persons in MSAR, those employed persons with unknown monthly earnings

were assumed to earn the overall median monthly income of employed population (Statistics and Census Serv-

ice, 2008). The mean annual incomes were estimated from the mean monthly incomes multiplied by 12. The

estimated mean monthly and annual incomes for employed persons (males and females) in the MSAR currency

(MOP) were translated to the Hong Kong (HK) currency. The exchange rate is around MOP$103 = HK$100 in the

past five years (Yahoo website 2008).

HK: The mean monthly income of 3,276,500 employed persons in Hong Kong by gender was estimated by using

the middle values of twelve monthly income categories and the number of employed persons in each category

obtained from the Women and Men in Hong Kong Key Statistics (Census and Statistics Department 2007). The

mean annual income was estimated from the mean monthly incomes multiplied by 12.

3.4.2.2 Productivity losses due to premature deaths

Productivity losses due to premature death as a short-term effect of air pollution were estimated for those who died

aged 15 to 64 in 2004 by calculating first the person years of life lost for each death under 65 years and using this with

average earnings to calculate the productivity losses.

PRD:

Number of deaths under age 65

The number of deaths in males (females) between ages 15 to 64 in each prefecture was estimated by multiplying

the population in 2004 by the proportion of males (females), by the proportion of persons aged 15 to 64 and by the

death rate (for any cause, both genders and aged 15 to 64) for each of the nine prefectures respectively. However,

the death rates for the nine prefectures were available for all ages only and therefore the Hong Kong death rates for

persons aged 15 to 64 were used (known death database from the Census and Statistics Department for the year

2004). Thus it has been assumed that the death rates for males and females aged 15 to 64 for the nine prefectures

were the same as those in Hong Kong.

The proportions of males and females in seven prefectures but not Dongguan and Jiangmen, was obtained for

2005 from published reports (中山市統計局 2005b; 佛山市統計局 2005a; 廣州市統計局 2005a; 惠州市統計

局 2005a; 深圳市統計局 2005; 珠海市統計局 2005a; 肇慶市統計局 2005a). For Dongguan and Jiangmen, the

proportions of males and females in Guangdong province was used instead (廣東統計信息網 2005) and were

assumed to apply to 2004. The proportion of the population in the age group 15 to 64 years in seven prefectures

was obtained as described in section 3.3.2.1 above. For the two remaining prefectures, Dongguan and Jiang-

men, this proportion was assumed to be the same as for Guangdong province.

Average person-years of life lost (PYLL) under 65

The average PYLL per death for males and females incurred between age 15 and 64 years in each prefecture was

assumed to be the same as the corresponding PYLL per death in Hong Kong because there was no comparable

data for PRD. The PYLL per death in Hong Kong was calculated as the PYLL for all who died aged 15 to 64 divided

by the number of decedents aged 15 to 64 in Hong Kong.


Therefore, the PYLL per death in Hong Kong was calculated as:

PYLL for all deaths aged 15 to 64 in Hong Kong / Number of deaths aged 15 to 64 in Hong Kong

The PYLL due to death before 65 years in each prefecture was estimated by multiplying the number of deaths

under 65 years in each prefecture (reference) by the average PYLL per death

The productivity losses due to premature death as a short-term effect for males and females in the nine

prefectures in the PRD were estimated by multiplying the average PYLL for those who died aged 15 to

64 by the reciprocal of the urban unemployment rate in 2004 (Statistics Bureau of Guangdong Prov-

ince, 2004) and by the relevant mean annual income in 2004 (Statistics Bureau of Guangdong Province

2005).

MSAR: The productivity loss due to premature deaths for all natural causes in MSAR was calculated by mul-

tiplying person-years of life lost for those aged 15 to 64 who died before 65 in 2004 with the labour force

rate (Statistics and Census Service, 2005b and 2007a), the employment rate (Statistics and Census Service,

2005b), and the annual mean incomes for males and females (converted from the estimated mean monthly

income (Statistics and Census Service, 2005b)) respectively. The exact age at deaths for each premature

death was not available, we therefore assumed these deaths incurred in the middle of the age range at

deaths (i.e. 27 for the range 15 to 39 years and 52 for 40 to 64 years) that were available from the Demo-

graphic Statistics 2004 (Statistics and Census Service, 2005c). Person-years of life lost were calculated by

subtracting these approximated age at death from 65 for these premature deaths.

HK: The productivity loss due to premature deaths for all natural causes in Hong Kong was calculated by

multiplying person-years of life lost for those aged 15 to 64 who died before 65 in 2004 (calculated from the

known death database in the Census and Statistics Department) with the labour force rate (Census and Statis-

tics Department, 2007), the employment rate (Census and Statistics Department, 2007), and the annual mean

incomes for males and females (converted from the estimated mean monthly income (Census and Statistics

Department, 2007)) respectively. Person-years of life lost were calculated by subtracting the age at death from

65 for each death which was obtained from the database on all deaths in 2004 provided by the Census and Sta-

tistics Department. The death pattern in 2002 was assumed to be the same as in 2004.

3.5 The attributable cost of health care due to air pollution

The annual burdens of the two main diseases were translated to monthly costs by dividing the total costs of illness and

productivity losses by 12. The attributable cost was estimated by assuming that the whole population was exposed

to the monthly ambient air pollution level in the relevant prefecture, MSAR or Hong Kong. With 100% exposure, the

attributable risk can be represented by the excess risk. The relevant attributable risk per 10 µg/m3 is labelled here as

the “health effect estimate”. This was multiplied by the monthly cost and the difference between the actual monthly

concentration and a reference value as below to give the health care cost of air pollution (CAP):


CAP = Monthly Cost * (Concentration – Reference level) * Health effect estimates

Where:

“Monthly Cost” is derived as above from the annual cost of illness, and productivity loss derived from the public hos-

pital admissions, public hospital out-patient, private hospital admissions, private hospital outpatients, and premature

deaths. Cardiovascular and respiratory morbidity and mortality were included and annual costs were translated to a

monthly cost after summation.

“Concentration” represents the monthly average air pollutant concentration if it exceeds the relevant Air Quality

Guideline (US EPA 2006, WHO 2006).

“Reference level” represents the air quality level or threshold below which no pollution related health outcomes are

attributed and hence no costs incurred. These are based on guideline values from US EPA (2006) for ozone and WHO

(WHO 2006) for the other pollutants (references).

“Health-effect estimates” are the attributable risk estimates per unit of pollutant derived from the excess risk esti-

mates which come from time-series models (Wong CM et al 2002, Wong TW et al, 2002). The time-series models are

concentration-response functions that describe the number of avoidable adverse health outcomes per unit change

in ambient air pollutant concentrations.

For example in 2004, the annual burden of cardiovascular and respiratory diseases in Guangzhou among all

the public hospital inpatients are estimated as RMB 693,221,797 and RMB 522,599,655 respectively. The excess

risks for hospitalisation per 10 µg/m3 of NO2 are 0.73% and 0.54% obtained from Hong Kong time series stud-

ies (see Table 3.1). If the average NO2 level in Guangzhou in one month is 92 µg/m3

(WHO guideline: annual

average is 40 µg/m3), the burden of cardiovascular and respiratory disease for public hospital inpatients in

that month which is avoidable by compliance with the WHO guideline is:

We have applied a strict dichotomous decision rule. If the average NO2 level in Guangzhou in one month is below 40 µg/

m3 , the pollutant concentration of NO

2 is regarded as zero (WHO guideline: annual average is 40 µg/ m3). The avoidable

burden of cardiovascular and respiratory diseases for public hospital inpatients in that month is:

Guideline values for air pollutants

Monthly average levels of PM10, NO2, SO2 and O3 in each prefecture of the PRD, Hong Kong, and Macao were compared with the annual (or the longest averaging time) average values in the WHO Air Quality Guidelines

= RMB 3,415,775

(92 – 40)693,221,797

12

100.0073

522,599,655

12 (92 – 40)

0.0054

10

0693,221,797

12

100.0073

522,599,655

12 0

0.0054

10

= RMB 0


for annual average levelsi (PM10: 20 µg/ m3; NO2: 40 µg/m3; SO2: 20 µg/m3) and the US EPA Air Quality 8 hour standard for O3: 40 µg/m3.ii, iii The purpose of deducting the guideline or standard (“reference level”) from the observed ambient level ( “concentration”) in the calculation is to contrast the health impacts of a poor air quality level with those of an arbitrary better or good air quality standard. The WHO guidelines and US EPA standards are to be regarded as safer levels but recent studies in adolescents indicate that concentrations below these levels are still strongly associated with significant negative health impacts.iv In our analysis it was assumed that when the air pollution level is below the guideline no health and productivity costs are incurred, but alternate (ie lower) baseline levels have been included in the sensitivity analysis.

3.6 Combining the effects of four air pollutants

This method was based on the previous air pollution and cost study (Hedley et al 2006). Using 1 to represent the 100%

contribution of PM10

, we first obtained the correlation between PM10

and NO2 then calculated the proportional varia-

tion of NO2 explained by PM

10 and subtracted this from 1. We then obtained and subtracted the correlation between

NO2 and SO

2 adjusted by PM

10 and that between PM

10 and NO

2 adjusted by SO

2 (Figure 3.3). For our main estimate we

assumed that only the contribution of PM10

and O3 were 100%, so the total number of avoidable health events associ-

ated with air pollution (T1) was estimated on the basis of partial correlation adjustment method (Figure 3.3):

4. Validation

4.1 Total cost based on estimates of PM10 derived from satellite remote-sensing

To assess whether the monthly average of air pollution levels recorded by the PRDRAQmn were consistent with that

recorded by other methods of air pollution measurements, we compared the monthly PM10

data recorded by the 9

monitoring stations in Guangdong with the satellite inferred concentration of PM10

derived from the 1-km resolution

satellite remote-sensing information of the aerosol optical depth (AOD) (IENV 2006).

The calculation of the inferred concentration was based on a linear regression model with the 2006 monthly average

PM10

levels reported by HK EPD as dependent variable and the 2006 monthly average AOD values obtained from the

HK monitoring station’s geographic locations as independent variable. To ensure the regression model produces a

reasonable prediction range of PM10

levels for PRD monitoring station, we used the HK station, which has maximum

and minimum PM10

levels most similar to that recorded in the PRD stations. In this study, Causeway Bay roadside sta-

tion was used.

i. World Health Organization. (2006). Air quality guidelines global update 2005: particulate matter, ozone, nitrogen dioxide and

sulfur dioxide. World Health Organization. Regional Office for Europe.

ii. US EPA (2006). Air Quality Criteria for Ozone and Related Photochemical Oxidants. (EPA 600/R-05/004 aF) Vol I, Chapter 7.

iii. The WHO annual standard was used for PM10

and SO2. Since there is no WHO annual standard for O

3, the US EPA air quality 8

hour (CHECK AGAINST STANDARD REWRITE )standard was used..

iv. Gauderman WJ, Vora H, McConnell R, Berhane K, Gilliland F, Thomas D, Lurmann F, Avol E, Kunzli N, Jerrett M, Peters J.

(2007). Effect of exposure to traffic on lung development from 10 to 18 years of age: a cohort study. Lancet. 2007 Feb

17; 369:571-577.


Inferred PM10

= 40.52 + 233.46*(AOD)

The regression model (R2 = 0.72) was then used to predict the PM10

levels at each PRD monitoring station by using the

monthly average AOD values obtained from each PRD station’s proxy geographic location (Appendix 3).

It must be noted that Satellite data can only serve as a validation but cannot be used to estimate the cost since it only

infers PM10

levels but not the other criteria pollutants which are associated with the health effects.

Table 4.1 shows the total cost due to PM10

based on 9 monitoring stations in Guangdong and satellite remote-

sensing.

4.2 Unit health care cost between the PRD and HK

The average cost per bed-day in the 9 prefectures was RMB578 and in HK was $2,727, which was 4.7 times higher.

The average cost per public outpatient visit in PRD was RMB 98 and for HK was $462, which was also 4.7 times

higher for HK. Table 3.5 shows the parameter list for comparison between 9 prefectures in PRD and HK.

4.3 Estimating utilisation

In Table 3.5, some of the inpatient utilisation data is estimated as indicated and some is real data taken from local pub-

lications. A validation of calculating the data using our estimation method and comparing with the real data for those

prefectures where we have this is shown in Table 3.5, section 4. It confirms that our estimation method has probably

Cost estimation based on T1 adjustment method represents the main results in this report.

T1 = PM10

+ 0.41NO2+ 0.84SO

2 + O

3.

PM10

NO2

(41%)

SO2

(84%)

(1-[0.768]2) = 0.41 NO2

(1-[0.67]2 - [0.39]2) = 0.84 SO2

Correlation between NO2 and PM10

Partial correlation between NO2 and SO2 adjusted by PM10

Partial correlation betwen PM10 and SO2 adjusted by NO2

Figure 3.3: Method for combining pollutant effects based on correlation between PM10

, NO2 and SO

2 at monitoring stations


under-estimated the real data and thus is a conservative estimation resulting in an underestimate of the PRD costs.

5. Findings

5.1 Annual attributable deaths, bed-days, doctor visits

The annual attributable number of deaths in the whole region (PRD + HK + Macao) was 9,519 of which 8,944 (94%)

were in the 9 prefectures of the PRD (Tables 5.1 and 5.2) with the largest numbers in GZ (3,306) and FS (1,926). The

attributable annual number of bed days at 400,303 for PRD plus Macao (Table 5.1) was ten times the number in Hong

Kong (Table 5.2).

5.2 Direct health care costs

The currency used in the PRD is the Renminbi (RMB) and in MSAR is the Macao Pataca (MOP). Costs are shown both in

their original currency units (except for MSAR currency which is already translated to HK$ in the model at an exchange

rate of MOP$103=HK$100). Costs were adjusted to parity with Hong Kong by multiplying by the ratio of PRD or Macao

to Hong Kong GDP per capita. The tables include both but the adjusted costs are most appropriate for comparison

with Hong Kong.

The estimated annual direct health care costs for the PRD and each of the nine prefectures, Macao, and Hong Kong are

shown in part one of Table 5.3. The unadjusted direct costs for the population in the PRD for all 4 pollutants is RMB 993

million, for Hong Kong is HK$ 839 million and for Macao is HK$ 7 million. The adjusted direct costs for the PRD are RMB

3.8 billion compared to HK’s cost of HK$ 0.8 billion; a 4- to 5-fold difference.

5.3 Indirect health care costs i.e. productivity loss

The unadjusted annual indirect costs of lost productivity are shown in part two of Table 5.3 as RMB 761 million for

all 4 pollutants in the PRD, HK$ 258 million in Hong Kong and HK$ 10 million in Macau. Adjusted figures show that

productivity loss for the PRD is about 11 times that of Hong Kong.

5.4 Sum of health care costs

The unadjusted sum of the annual health care costs and productivity loss due to the health detriment caused by air pollution

was RMB 1.8 billion for PRD, HK$ 1.1 billion for Hong Kong and HK$ 18 million for Macao (Table 5.3, part three). After adjust-

ment for relative differences in GDP per capita, the PRD cost was RMB 6.7 billion, seven times that of Hong Kong. Adjusted costs

in PRD prefectures ranged from RMB 119 million in Zhuhai to RMB 2.4 billion in Guangzhou.

5.5 Comparison of costs between PRD, MSAR and HK

Since the population sizes were different in the PRD, MSAR and Hong Kong, costs were scaled to obtain the costs per

1 million population. The estimated annual direct health care costs per one million population in each of the nine

prefectures in PRD, MSAR and Hong Kong are shown in part one of Table 5.4. The average adjusted costs per 1 million

population in the PRD were RMB 115 million for direct costs and RMB 95 million for lost productivity with just over

half the sum of RMB 210 million per 1 million population (Table 5.4, part three) due to direct costs. For MSAR, the pro-

ductivity loss makes up a larger part (59%) of the sum of HK$ 38 million per million population and the HK costs per

million population are HK$ 162 million with 76% due to direct costs of health care.


Figure 5.1: Total monthly costs due to 4 air pollutants in PRD, MSAR and HK in 2004


The monthly costs due to the 4 air pollutants in PRD, MSAR and HK are shown in Figure 5.1.

5.6 Total cost based on estimates of PM10 derived from satellite remote-sensing

After using the estimates of PM10

concentrations derived from satellite remote-sensing data, the total cost for the

burden of disease due to PM10

increased 14% for PRD. Shenzhen, Zhuhai, Jiangmen, and Zhongshan increased by

more than 50% (53% to 234%), Zhaoqing increased 31%, and the rest (Guangzhou, Foshan, Huizhou, Dongguan)

changed less than 15% (-14% to 8%) (Table 4.1).

6. Sensitivity Analyses

6.1 Total cost based on simple summation of the effect of all 4 pollutants

Air pollutants are inter-correlated, i.e. the high level of one pollutant could be associated with a high level of

another pollutant. We have evidence from studies in Hong Kong and elsewhere that each of the criteria pol-

lutants is likely to have at least some independent effect. The procedure which we used for summation has

face validity and has been peer reviewed (Hedley et al 2008). We have called it T1 in this report. As a sensitivity

analysis, we compared the results of T1 with the total cost based on a simple summation of the effects of all 4

pollutants (T2) i.e. a possible maximum effect. After using T2, the total cost for the burden of disease due to all 4

pollutants increased, as expected, from $1.8 billion for PRD, $1.1 billion for HK and $16 million for MSAR to $2.1

billion, $1.4 billion and $20 million respectively (Table 6.1).

6.2 Total cost based on other methods of adjusting the summation of the effect of all 4 criteria pollutants

To assess the impact of other methods of adjusting the summation, we compared the original estimate (T1) with the

total costs obtained by seven alternative adjusted summations using (i) SO2 as the dominant pollutant instead of PM

10

(T3), (ii) NO2 as the dominant pollutant (T4); (iii) the single pollutant with the greatest impact (excess risk * pollutant

reduction) (T5), (iv) PM10

plus O3 only (T6), (v) the single pollutant (among PM

10, SO

2 and NO

2) with the greatest impact

together with O3 (T7) and (vi) SO

2 alone (T8). The only one which made a lot of difference was T6 which reduced the

PRD costs to $0.9 billion, HK to $0.8 billion and MSAR to $10 million.

6.3 Direct and indirect health care cost based on different estimations of health care utilization andcosts data

Some of our estimates of health care utilization and costs in the PRD are inevitably uncertain. To assess the effects

of varying one parameter at a time, we performed sensitivity analyses by using different calculation methods for the

values of some selected parameters to examine the effect on the estimation of direct and indirect cost due to all 4

pollutants as shown in Tables 6.4 to 6.8. The selected parameters are:

(i) Total bed-days of private hospitals of 9 prefectures in PRD(Table 6.4)

(ii) Proportion of number of hospital inpatients of each disease of 9 prefectures in PRD(Table 6.5)

(iii) Average cost per bed-day in public hospital of 9 prefectures in PRD(Table 6.6)


(iv) Average cost of an inpatient episode in Shenzhen (Table 6.7).

(v) Number of hospital inpatient episodes among the employed population in PRD (Table 6.8)

6.4 Total cost based on mean income and median income in HK and MSAR

In our main models for the nine prefectures in PRD, MSAR and HK, mean income was used to estimate the pro-

ductivity loss due to hospital episodes and premature deaths. Mean income was used in the models because

only mean income for the nine prefecture in PRD was available from the internet. The Census and Statistics

Department in HK and the Statistics and Census Service in MSAR reported median monthly employment earn-

ings only. We therefore calculated the mean income in HK and MSAR for consistency and comparison to 9

models for PRD. To see the effect on the total cost by changing from mean income to median income for both

the HK and MSAR models, a further sensitivity analysis is shown in Table 6.9.

7. Discussion

The emergence of China as the world’s factory for almost all popular consumer goods and domestic and commercial equip-

ment has been fuelled by very high consumption of fossil fuels which give rise to complex pollutant mixtures which cause

acute and long term injury to health. Although the consumption of energy in relation to GDP has fallen, and particularly

the consumption of coal which has been a principal source of particulates and SO2 during the past 25 years, oil consump-

tion has increased and China is still regarded as an inefficient energy intensive economy. Recognition of the external costs

should be a driver of policy directed at air quality controls and health protection. In 1997 the World Bank Report Clear Water,

Blue Skies estimated that the total external costs of air and water pollution amounted to 7.7% of China’s GDP.

Health gains from social and economic development will be compromised if population health is eroded by the

multisystem effects of a ubiquitous hazard such as high ambient air pollution levels. The reasons for urgent action

to achieve pollution abatement include the preservation of the aesthetic value of the environment, protection of

ecology, and most importantly protection of sensitive cell systems and tissues in the cardiovascular and pulmonary

organs, growth and development of the developing foetus.

The findings of this study are indicative of an iceberg of disease with very many residents of the region suffering

health detriment sufficient to make them consult a doctor, many having such serious conditions that they are admit-

ted as inpatients and of these, a large number dying prematurely. These estimates of doctor visits, hospital bed days

and deaths are important markers of pain, suffering and impaired loss of life. The monetary estimates which we have

made of the cost of the associated health care only represents a small part of the real cost of this health impairment.

This report has used a conservative approach to the estimation of excess community costs due to air pollution by

taking the WHO guideline/US EPA standard levels as reference values. In reality, the relationship between air pol-

lution and harm to health is a continuum, and there are no known thresholds for air pollutants below which zero

health effects occur. While this level of air pollution reduction will not avoid all costs of air pollution it would provide

a reasonable target to aim for in the short term. Furthermore, the monetary valuation of the costs has not included

the value of any intangible costs such as pain and suffering or value of lives lost. The estimation of productivity loss is

based only on years of life lost due to deaths resulting from high air pollution. It does not include the harm and result-

ing premature deaths incurred as a result of longer-term exposures such as those experienced by children growing

up in Hong Kong, Macao and the PRD in recent years.

There are a variety of methods to adjust the monetary value of health costs across the region to obtain parity for


comparisons. We have chosen to use the ratio of per capita GDPs partly because of the easy availability of GDP esti-

mates for each area in which we were interested and because it represents well the difference between the relatively

wealthy areas of Hong Kong and Macao and the mainland prefectures.

The adjusted annual costs of air pollution per capita in the PRD are about a third higher than those in Hong Kong, while the

costs for Guangzhou are twice, and for Foshan are almost four times those in Hong Kong. This reflects the high air pollution

levels and risks to individuals in these prefectures, particularly from very high reported sulphur dioxide levels. This pollutant

has been found to be strongly associated with mortality and cardiovascular disease in previous studies, and causes a the heavy

burden of health care costs that these prefectures will continue to bear until air pollution levels are significantly reduced.

We believe that the application of Hong Kong risk estimates, which are comparable to those in other Chinese cities

obtained using exactly the same methodological protocol, is a valid and necessary approach to estimating the burden

of pollutant related disease in the PRD. To date, there is no specific information on the relationship of pollutant concen-

trations and health outcome in PRD. However, in a study with three Asian countries and Hong Kong, there appeared to

a positively linear dose-response relationship between all natural mortality and pollutants. Factors which will lead to

variations in the burden of disease and health costs in different prefectures include the absolute determinant of life-time

health experience and life expectancy.

The air pollution studies in HK from which the risk estimates are derived were based on analyses of millions

of hospital admissions and over one hundred thousand deaths. The findings are comparable to risk estimates

obtained by similar methodology in other geographic regions in Europe, Canada and the US. The main differ-

ence is that the excess risks per 10µg/m3 for gaseous pollutants, NO2 and SO

2, are larger in Hong Kong (and also

in Shanghai and Wuhan) than in the West. The opposite holds for PM effects. In this survey we have considered

carefully the validity of the analytical procedures we have used to study the PRD population. Population based

studies in Hong Kong over a twenty year period have examined the short and intermediate term impact of pol-

lution on the health and health care utilization of both children and adults. Time series studies based on Poisson

regression were used to examine the relationship between daily pollutant concentrations and health outcomes.

Four substantive studies determined the relative risks for primary care (doctor visits), secondary care (hospital

admissions) and mortality (all natural causes) and three of them are published in high quality international jour-

nals while the fourth is accessible from the HKEPD web site.

There are a number of limitations in this study due to lack of data. The main areas in which data is lacking, the assumptions

made to compensate for this lack and the subsequent implications of the estimates are described here.

1. Since the average pollution level in PRD was much higher than that in HK, we would expect their risk of illness

to be higher. This might affect the risk per unit of pollutant but we do not have data on this risk for PRD. We have

therefore applied the risk estimates derived from HK to the pollution levels in the PRD. The health costs due to air

pollution might therefore be underestimated if the risk per unit of pollutant in PRD is higher than in HK. Neverthe-

less, we assume that the mortality and morbidity coefficients from Hong Kong, as the only best available source in

Southern China, are applicable to the PRD and MSAR populations

2. Since we have had to estimate some components of the burden of illness and/or the related costs, the costs

reported here may not exactly correspond to the actual monetary costs for each of the prefectures if these could

be estimated. Also the amount of variation that would actually occur might be under-represented since we have

often assumed that estimated values were the same in each prefecture. However, they should give a reasonable

comparison of the relative costs where the main components which differ between prefectures are air pollution

levels and populations size.


3. The length of stay in hospital for each illness episode was assumed to be the same in the other 8 prefectures

as it was in GZ. Actually, the population age distribution varies between prefectures as can be seen in Table 3.4

and HK data from the HA in 2002 (Hong Kong Hospital Authority, 2002) shows that older people tend to have a

longer mean LOS. Therefore, if the inpatient population reflects the population age proportions then for those

prefectures whose population is older than GZ we may have under-estimated the costs and for those whose

population is younger, we may have over-estimated the costs.

4. For previous valuations of productivity loss we have used median earnings which are lower than mean

earnings. However PRD only reports mean earnings and so, for comparability, we had to use the mean

for HK. This will make the HK estimate for productivity loss higher than previous estimates. We had to

estimate mean monthly employment earnings for HK since the Census and Statistics Department only

reports median monthly employment earnings. We did this by taking the mid point of each earning band

and multiplying by the number of people in each band and dividing the sum for all bands by the number

of employed people.

5. As shown in the validation section, where we were able to validate our estimates, we found that they all tended

to under-estimate the costs for PRD.

Some of the findings from the model are of interest and could be further validated. For example, the number

of episodes in a public or private hospital are expressed per 1 million population in Table 3.4. A comparison

of the utilisation pattern in the 9 prefectures with HK shows that HK public hospital utilisation is higher than

all the 9 prefectures except Zhongshan for respiratory diseases. HK private hospital utilisation is substantially

higher than the 9 prefectures being up to 4.6 times higher for cardiovascular diseases and 5.9 times higher for

respiratory diseases.

Private sector outpatient utilisation in HK was very much higher than that in the PRD whereas in the public sector, the

utilisation in the prefectures with real data was higher than HK. Therefore, people seem to use the public sector much

more than the private sector in the PRD.

Although the air pollution levels in Macau are as high as in Hong Kong, the utilization was relatively low resulting in low

monetary values for the health impacts. The population in Macau is a bit younger than the Hong Kong population but that

does not fully account for the difference. It is possible that some utilization data is not recorded, that there is a greater use of

Chinese medicine which we have not accounted for or that residents travel elsewhere for their health care.

The 14% increase of the total cost after using satellite inferred PM10

data was mainly due to the large increase

(>50%) in Shenzhen, Zhuhai, Jiangmen, and Zhongshan. We believe that the large difference is due to these four

monitoring stations being located in a relatively clean environment. Shenzhen station located inside a big park,

Zhuhai station located inside a University surrounded by clean environment, Jiangmen station located inside a

lake area, and Zhongshan station located inside an ecological park (Appendix 6). As a result, their recorded PM10

levels were lowered and hence may not reflect the exposure of the majority of the general population who live

in the urban area.

The proxy geographic locations are determined by map overlaying based on the PRDRAQmn annual report

2006. Although there may be errors in approximating the exact locations in this method, the AOD values of

the proxy locations appear to reflect a better estimate of PM10

level of the surrounding area of the monitoring

station. The large difference between the recorded levels and the inferred levels of PM10

indicates that these

monitors’ measurements might not adequately represent the nearby area. All of these real measurements


show a large reduction from the inferred PM10

levels, indicating that these monitoring stations are likely to

greatly under-estimate the average air pollution level of the whole prefecture. Their representativeness is thus

in some doubt.

The estimates of costs here are conservative in that many health outcomes are not included. However although

under-estimation of health effects may arise because of incomplete epidemiological information and the use of short

term risk estimates from time series analyses compared with cohort studies, some over-estimation may occur through

double counting of outcomes by treating each of the criteria pollutants as independent risks.

In our sensitivity analyses there was little variation among all estimates based on different combinations of pollut-

ants. The combination of PM10

and O3, suggested by the WHO Working Group (2003), gave the lowest estimate for

deaths and overall costs but was likely to under-estimate the community burden (Hedley et al 2006). There are many

ways to estimate the costs of a pollutant mixture. Using just the effect of PM10

effect or PM10

+O3 is common (Wong

EY et al 2004, Medina S et al 2004, Ontario Medical Association 2005). However, local data is important in estimating

the avoidable health impacts and their costs, particularly data on the sources of pollutants, their composition and

the health effects. An intervention study demonstrated the benefits gained from reducing SO2 (Hedley et al 2002).

A series of Asian time series studies on air pollution also identified the importance of health effects due to gaseous

pollutants. Taking these gaseous pollutants into account is important in Asian countries. In this study we have not

considered the toxicity of different compositions of particles or effect modification such as by smoking. In general,

our approach is conservative.

The number of inpatient and outpatient episodes varied among prefectures. This may be a data problem or a

real difference due to accessibility of medical facilities in cities, or other socio-economic differences between 9

prefectures.

In this study, the direct medical costs and cost of lost productivity in Hong Kong were $0.8billion and $0.3billion

respectively, a total of $1.1 billion per year. This corresponds to our previous estimate based on visibility where the

benefits of achieving air pollutant levels equivalent to the better visibility were also around $1 billion. Although, we

consider that Hong Kong should aim for more stringent levels of pollutant control, equivalent in our previous study

of the good visibility levels, we acknowledge that this target may be less feasible for the PRD in the immediate future.

However, this should be the longer term goal and we should see the costs reported here as an interim estimate of the

benefits achievable by air pollution control.

Data limitations

The following are the main data limitations we encountered in the study:

• Lack of comprehensive data for the 9 prefectures in the PRD and what data is available tends to be publicly avail-

able on websites and accuracy and reliability are difficult to determine.

• Lack of any data for many of the prefectures except Guangzhou and Shenzhen. Thus many assumptions with no

validation had to be made.

• Daily air pollution data is not available. Therefore we could only apply the daily time-series coefficients to monthly

air pollution levels. On the other hand, there is no local data on long term health effects. As we know that risk

estimates from cohort study are larger than that from time-series, this is further evidence that our approach will

not over-estimate the costs.


• Lack of pollutant data other than the criteria air pollutants. Metal species, VOCs, CO were not taken into account

yet in our estimation as these unmeasured are not available today yet. Nevertheless, this is still in line with our

approach – a conservative approach not to over-estimate.

• No data on health care utilization and costs in the private sectors except the number of inpatient and outpatient

episodes in Guangdong province. Our estimates of unit costs on private health care sector are based on the

public hospitals which may subject to some bias.

• No data on time-off work per outpatient visit in Guangdong province. Thus productivity losses due to air pollu-

tion were underestimated.

• Only median incomes for males and females are reported by the Census and Statistics Department in

Hong Kong, the mean annual incomes were therefore the best estimates based on our own calculation.

• Lack of precise data for health care utilization and costs. For example, the unit costs for different diseases catego-

ries, females and males, different types of hospitals and different age groups were assigned the same values.

• No data on the costs of self medication. Only the percentage of sick persons who self medicated in China was found,

but the mean costs of self medication could not be found. Thus the health care costs were underestimated.


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34Tables


Tabl

e 3.

2: P

aram

eter

list

for d

irect

and

indi

rect

hea

lth c

are

cost

in P

earl

Rive

r Del

ta (P

RD)

Pub

lic h

osp

ital

inp

atie

nts

GZ

SZZ

HFS

JMZQ

HZ

DG

ZS

1. C

ost

per

ep

iso

de

(a

) Mea

n L

OS

(day

s)

C

ardi

ovas

cula

r dis

ease

s16

.4Sa

me

as G

Z

Resp

irato

ry d

isea

ses

10.0

(b

) Ave

rag

e co

st/ b

ed-d

ay (R

MB

)80

4 58

9 60

2 52

7 64

3 44

5 60

2 5

26

463

2. N

o. o

f ep

iso

des

C

ardi

ovas

cula

r dis

ease

s 5

2,57

5 5

,952

9

,080

4

5,31

3 1

3,89

5 1

4,20

2 1

0,56

8 5

,838

2

1,97

5

Re

spira

tory

dis

ease

s 6

5,00

1 7

,360

1

1,22

8 5

6,03

4 1

7,18

2 1

7,56

2 1

3,06

8 7

,219

2

7,17

4

Pub

lic h

osp

ital

ou

tpat

ien

ts

1. A

vera

ge

cost

per

vis

it (R

MB

)13

6 12

6 11

6 7

6 9

3 73

1

22

70

67

2. N

o. o

f vis

its

C

ardi

ovas

cula

r dis

ease

s 3

,967

,038

3

00,5

12

156

,820

3

,248

,605

7

01,5

87

717

,093

5

33,6

07

294

,751

1

,303

,208

Re

spira

tory

dis

ease

s 4

,905

,612

3

71,6

11

193

,922

4

,017

,203

8

67,5

78

886

,753

6

59,8

55

364

,487

1

,611

,538

Priv

ate

ho

spit

al in

pat

ien

ts

1. C

ost

per

ep

iso

de

(a

) Mea

n L

OS

(day

s)

C

ardi

ovas

cula

r dis

ease

s16

.4Sa

me

as G

Z

Resp

irato

ry d

isea

ses

10.0

(b

) Ave

rag

e co

st/ b

ed-d

ay (R

MB

)80

.458

960

252

764

344

560

252

646

3

2. N

o. o

f ep

iso

des

C

ardi

ovas

cula

r dis

ease

s88

919

910

442

346

558

735

319

516

8

Re

spira

tory

dis

ease

s1,

099

246

128

523

575

437

241

208

Priv

ate

ho

spit

al o

utp

atie

nts

1. A

vera

ge

cost

per

vis

it (R

MB

)13

612

611

676

9373

122

7067

2. N

o. o

f vis

its

Re

spira

tory

dis

ease

s52

,758

11,8

106,

163

25,0

9527

,573

28,1

8220

,971

11,5

849,

973


Tabl

e 3.

2: (C

ontin

ued)

Dem

og

rap

hic

GZ

SZZ

HFS

JMZQ

HZ

DG

ZS

1. P

op

ula

tio

n 7

,376

,720

1

,651

,346

8

61,7

41

3,5

08,8

98

3,8

55,2

99

3,9

40,5

07

2,9

32,2

30

1,6

19,6

90

1,3

94,4

50

2. P

rop

ort

ion

of p

op

ula

tio

n

ag

ed 0

-14

(%)

14.7

88.

7916

.26

14.0

621

.32

26.6

119

.90

21.3

213

.51

ag

ed 1

5-64

(%)

77.6

689

.61

78.2

180

.09

71.2

764

.32

72.5

271

.27

82.0

7

ag

ed 6

5 or

ab

ove

(%)

7.56

1.60

5.53

5.85

7.41

9.07

7.58

7.41

4.42

3. P

ropo

rtio

n of

pop

ulat

ion

by g

ende

r (%

)

Fe

mal

e 49

.63

49.0

749

.57

48.0

449

.35

50.2

348

.14

49.3

549

.37

M

ale

50.3

750

.93

50.4

351

.96

50.6

549

.77

51.8

650

.65

50.6

3

4. E

mp

loym

ent r

ate

(%)

97.9

297

.51

97.2

197

.97

97.3

397

.30

97.4

098

.50

97.7

0

5. M

ean

yea

rly

inco

me

(RM

B)

31,

025

31,

808

20,0

27

19,3

69

13,

653

14,7

53

14,1

76

25,

207

22,

302

6. D

eath

rate

per

100

0 p

erso

ns

(a

ll ca

uses

, all

ages

)5.

641.

373.

024.

115.

30

5.70

4.

384.

60

6.03

7. G

DP

per

cap

ita

(RM

B)

6345

659

271

4184

847

658

3079

126

468

3768

171

995

4400

6


Table 3.3: Parameter list for direct and indirect cost in MSAR (M)

Public hospital inpatients All ages Aged 15-64

1. Cost per episode

(a) Mean LOS (days)

Cardiovascular diseases

Female and male 5.27 —

Respiratory diseases


(b) Average cost/ bed-day (HK$) 2,911 —

2. No. of episodes


Female and male 572 —


Female and male 839 —

Public hospital outpatients and other outpatients

1. Average cost per visit (HK$)

(a) S. Januario Hospital 366 —

(b) Public health care centres and other establishments providing health care 366 —

(c) Accident and Emergency in S. Januario Hospital 531 —

2. No. of visits

(a) S. Januario Hospital

Cardiovascular diseases 10,888 —

Respiratory diseases 4,623 —

(b) Public health care centres and other establishments providing health care

Cardiovascular diseases 148 —

Respiratory diseases 35 —

(c) Accident and Emergency in S. Januario Hospital

All reasons 154,622 —




Private hospital inpatients All ages Aged 15-64

1. Cost per episode

(a) Mean LOS (days)





(b) Average cost/ bed-day (HK$) 2,911 —

2. No. of episodes


Female and male 1,173 —


Female and male 1,508 —

Private hospital outpatients and other outpatients

1. Average cost/ visit (HK$)

(a) Accident and Emergency in Kiang Wu Hospital 531 —

(b) Private clinics, centres for auxiliary diagnostic examinations and other establishments providing health care

152 —

2. No. of visits

(a) Accident and Emergency in Kiang Wu Hospital

All reasons 112,361 —



(b) Private clinics, centres for auxiliary diagnostic examinations and other establishments providing health care


Table 3.3 (Continued)


Demographic

1. Population 462,637 347,684

2. Employment rate (%)

Overall 95.1 —

Female 96.0 —

Male 94.4 —

3. Mean monthly income

Overall (MOP$) 7,605

Female (MOP$) 6,303 —

Male (MOP$) 8,779 —

Overall (HK$) 7,384

Female (HK$) 6,120

Male (HK$) 8,523

4. Median monthly income

Overall (MOP$) 5,167

Overall (HK$) 5,017

5. Labour force rate (%)

Overall — 62.0

Female — 56.4

Male — 68.2

6. Total person-years of life loss (Premature death for persons aged 15 to 64 who died before 65)

Female — 2,199

Male — 3,985

7. Death rate aged 15 to 64 (per 1000 population)

Female — 0.8439

Male — 1.8764

8. GDP per capita (MOP) 181,580 —

Note: “—“indicates no information obtained or used in the estimation

Table 3.3 (Continued)


Table 3.4: Parameter list for direct and indirect cost in Hong Kong(HK)

Public hospital inpatients All ages Aged 15-64

1. Cost per episode

(a) Mean LOS (days)


i. Acute General

Female 5.2 4.4

Male 5.1 3.9

ii. Chronic Infirmary

Female 19.7 22.4

Male 21.4 16.0


i. Acute General

Female 5.6 4.3

Male 5.4 3.8


Female 17.1 14.0

Male 16.1 9.6

(b) Average cost/ bed-day ($)

i. Acute General 2,911 —

ii. Chronic Infirmary 2,542 —

2. No. of episodes


i. Acute General

Female 60,592 18,031

Male 62,908 25,341


Female 7,003 903

Male 6,173 1,454


i. Acute General

Female 43,595 12,481

Male 67,384 20,842


Female 5,605 436

Male 10,612 1,529


Table 3.4: (Continued)

Public hospital outpatients All ages Aged 15-64

1. Average cost per visit

(a) General Outpatient Clinic

i. Department of Health 204 —

ii. Hospital Authority 281 —

(b) Special Outpatient Clinic 613 —

(c) Accident and Emergency 531 —

2. No. of visits

(a) General Outpatient Clinic


i. Department of Health 92,644 —

ii. Hospital Authority 712,632 —


i. Department of Health 99,811 —

ii. Hospital Authority 767,762 —

(b) Special Outpatient Clinic


i. Medicine 222,805 —

ii. Surgery 101,035 —


i. Medicine 240,041 —

ii. Surgery 108,851 —

(c) Accident and Emergency



Private hospital inpatients All ages Aged 15-64

1. Total numbers of bed-days

Cardiovascular diseases 61,971 10,503

Respiratory diseases 59,828 15,061

2. Average cost/ bed-day ($) 2,911 —

Private General Practitioner Visit

1. Average cost/ visit ($) 152 —

2. No. of visits

Respiratory diseases 25,561,431 —



Demographic

1. Population 6,783,500 —

2. Employment rate (%)

Female 94.4 —

Male 92.2 —

3. Mean monthly income ($)

Female 12,751.58 —

Male 17,207.85 —

4. Labour force rate (%)

Female — 51.9

Male — 81.8

5. Total person-years of life loss (Premature death for persons aged 15 to 64 who died before 65)

Female — 40,665

Male — 75,028

6. Death rate aged 15 to 64 (per 1000 population)

Female — 0.9814

Male — 2.2614

7. Deflation rate (%)

Year 1999 4.0 —

Year 2000 3.8 —

Year 2001 1.6 —

Year 2002 3.0 —

Year 2003 2.6 —

Year 2004 0.4 —

8. GDP per capita 190,448 —

Note: “—“indicates no information obtained or used in the estimation


Tabl

e 3.

5: P

aram

eter

list

for c

ompa

rison

bet

wee

n 9

pref

ectu

res i

n Pe

arl R

iver

Del

ta (P

RD) a

nd H

ong

Kong

(HK)

Dem

og

rap

hic

GZ

SZZ

HFS

JMZQ

HZ

DG

ZS

HK

1. P

op

ula

tio

n7,

376,

720

1,65

1,34

6 8

61,7

41

3,50

8,89

8 3,

855,

299

3,94

0,50

7 2,

932,

230

1,61

9,69

0 1,

394,

450

6,78

3,50

0

2. P

rop

ort

ion

of p

op

ula

tio

n

A

ged

0-14

(%)

14.7

88.

7916

.26

14.0

621

.32^

26.6

119

.90

21.3

2^13

.51

14.8

2

A

ged

15-6

4 (%

)77

.66

89.6

178

.21

80.0

971

.27^

64.3

272

.52

71.2

7^82

.07

73.1

1

A

ged

65 o

r ab

ove

(%)

7.56

1.60

5.53

5.85

7.41

^9.

077.

587.

41^

4.42

12.0

7

3. M

ean

yea

rly

inco

me

(RM

B /

HK

$) 3

1,02

5 3

1,80

8 20

,027

19

,369

1

3,65

3 14

,753

14

,176

2

5,20

7 2

2,30

2 F:

605

,943

M: 9

55,9

46

4. G

DP

per

cap

ita

(RM

B /

HK

$)63

,456

59,2

7141

,848

47,6

5830

,791

26,4

6837

,681

71,9

9544

,006

190,

448

Pub

lic h

osp

ital

inp

atie

nts

1. M

ean

LO

S (d

ays)

C

ardi

ovas

cula

r dis

ease

s16

.412

.9

Re

spira

tory

dis

ease

s10

.011

.1

2. A

vera

ge

cost

/ b

ed-d

ay (R

MB

/ H

K$)

804

589

602

527

643

445

602

526

46

3 A

cute

:2,9

11

CR:

2,5

42

3. N

o. o

f epi

sode

s@ (p

er 1

mill

ion

popu

lati

on)

C

ardi

ovas

cula

r dis

ease

s 7

,127

* 3

,604

+

10,

537#

12,

914#

3,6

04+

3,6

04+

3,6

04+

3,6

04+

15,

759#

20,1

48*

Re

spira

tory

dis

ease

s8,

812*

4,

457+

13

,030

# 1

5,96

9# 4,

457+

4,

457+

4,

457+

4,

457+

1

9,48

8#18

,751

*

4. N

o. o

f ep

iso

des

@ (w

ho

le p

op

ula

tio

n)

C

ardi

ovas

cula

r dis

ease

s52

,575

*26

,587

+5,

952+

9,08

0#

3,1

06+

45,3

13#

12,6

46+

13,8

95+

14,2

02+

10,5

68+

5,83

8+21

,975

#

5,02

6+20

,148

*

Re

spira

tory

dis

ease

s65

,001

*32

,877

+7,

360+

11,2

28#

3,84

1+

56,0

34#

15,6

39+

17,1

82+

17,5

62+

13,0

68+

7,21

9+27

,174

#

6,21

5+18

,751

*


Tabl

e 3.

5: (c

ontin

ued)

Pub

lic h

osp

ital

ou

tpat

ien

tsG

ZSZ

ZH

FSJM

ZQH

ZD

GZ

SH

K

1. A

vera

ge

cost

per

vis

it (R

MB

/ H

K$)

136

126

116

76

93

73

122

70

67

G

OPC

: 243

SO

PC: 6

13

A&

E: 5

31

2. N

o. o

f vis

its@

(per

1 m

illio

n p

op

ula

tio

n)

C

ardi

ovas

cula

r dis

ease

s53

7,77

8# 1

81,9

80+

181

,980

+

925

,819

# 1

81,9

80+

181

,980

+

181

,980

+

181

,980

+

934,

568#

207,

225*

Re

spira

tory

dis

ease

s66

5,01

3# 2

25,0

35+

225

,035

+

1,14

4,86

2# 2

25,0

35+

225

,035

+

225

,035

+

225

,035

+

665,

013#

223,

256*

Priv

ate

ho

spit

al in

pat

ien

ts

1. T

ota

l no.

of b

ed-d

ays

@

(per

1 m

illio

n p

op

ula

tio

n)

C

ardi

ovas

cula

r dis

ease

s1,

976

9,13

5*

Re

spira

tory

dis

ease

s1,

490

8,82

0*

Priv

ate

ho

spit

al o

utp

atie

nts

1. N

o. o

f vis

its@

(per

1 m

illio

n p

op

ula

tio

n)

Re

spira

tory

dis

ease

s5,

784

3,76

8,17

7

An

nu

al a

vera

ge

air

po

lluta

nt c

on

cen

trat

ion

(µ

g/m

3 )

1. P

M10

8960

4111

570

7910

394

4155

2. N

O2

4961

4079

3750

3456

5057

3. S

O2

7327

5110

837

6721

7459

23

4. O

345

3948

3837

4754

5445

32

^ in

dica

tes

no d

ata

avai

lab

le a

nd G

uang

dong

dat

a w

as u

sed

inst

ead

* th

e no

. of e

pis

odes

/vis

its a

re re

al d

ata

# th

e no

. of e

pis

odes

/vis

its fo

r all

dise

ases

wer

e ob

tain

ed a

nd th

e no

. of e

pis

ode/

visi

ts fo

r eac

h di

seas

e w

ere

estim

ated

by

the

pro

por

tion

of e

ach

dise

ase

in G

Z+

the

no. o

f ep

isod

es/v

isits

for a

ll di

seas

es w

ere

estim

ated

by

GD

num

ber

of e

pis

odes

for a

ll di

seas

es a

djus

ted

by p

opul

atio

n si

ze in

eac

h p

refe

ctur

e an

d th

e p

rop

ortio

n of

eac

h di

seas

e in

GZ

@ ne

wly

add

ed p

aram

eter


Table 3.6: List of assumptions adopted in the study

Air pollutant data

1. Averages of the monthly average data from 9 monitoring stations in Guangdong represented the province-wide monthly estimates.

2. Averages of the monthly average data from 2 general monitoring stations in MSAR represented the region-wide monthly estimates.

3. Averages of the monthly average data from 10 general monitoring stations in Hong Kong represented the city-wide monthly estimates.

Health care costs due to air pollution

4. No incurring direct and indirect health care costs due to air pollution if the air pollution levels were below the values of the WHO Air Quality Guideline (WHO 2005) and the US EPA Air Quality Standards.

Direct health care costs

5. Two main categories of diseases were related to air pollution: cardiovascular and respiratory diseases.

6. The mean lengths of stay (LOS) in the other eight prefectures in the Pearl River Delta (including Shenzhen, Zhuhai, Dong-guan, Zhongshan, Foshan, Huizhou, Jiangmen and Zhaoqing) were the same as that in Guangzhou for both diseases

7. The mean LOS in the nine prefectures in the Pearl River Delta for both diseases were the same for public and private hos-pitals and for both gender.

8. The mean LOS for both diseases in private hospital in MSAR were the same as those in public hospital.

9. The mean LOS in public hospitals for both diseases in Hong Kong in 2002 were the same as that in 2004.

10. The proportion of the number of bed-days in public and private hospitals in Hong Kong in 2000 was the same as that in 2004.

11. The average costs per bed-day in non-profit general hospitals in all prefectures of PRD were the same as for all public andprivate hospitals, for both gender and for both diseases.

12. The average costs per bed-day in the public and private hospitals in MSAR were assumed to be the same as that in HA acute general hospitals in Hong Kong.

13. The average costs per bed-day in HA acute general and chronic infirmary hospitals in Hong Kong were the same for bothgender and for both diseases.

14. The average costs per bed-day for private hospitals in Hong Kong were the same as HA acute general hospitals for both diseases.

15. The annual numbers of public and private hospital episodes for all diseases in Guangdong were used for four prefectures (i.e. Dongguan, Huizhou, Jiangmen and Zhaoqing) with adjustment according to the proportion of the population sizes of the prefectures.

16. The annual numbers of private hospital admissions for all diseases in Guangdong province in 2003 were the same as that in 2004.

17. The proportion of public and private inpatient episodes for cardiovascular and respiratory diseases in Guangzhou were the same as that in the other eight prefectures.

18. The annual numbers of inpatient episodes in Hong Kong for cardiovascular and respiratory diseases in 2002 were the same as that in 2004.

19. The average cost per outpatient visit in non-profit general hospitals for the nine prefectures was the same for privatehospitals, for all diseases and for both gender.

20. The average costs per outpatient visit in public hospital outpatient, public health care centres and other public establishments providing health care in MSAR were assumed to be the same as the average costs of GOPC and SOPC visits in Hong Kong.

21. The average costs per A&E visit in public and private hospital in MSAR were assumed to be the same as that in Hong Kong.


22. The average costs per outpatient visit in private clinics, private centres for auxiliary diagnostic examinations and other private establishments providing health care in MSAR were assumed to be the same as the cost of a private general prac-titioner (GP) visit in Hong Kong.

23. The average costs per visit in GOPC, SOPC, A&E and private GP in Hong Kong were the same for all diseases and for both gender.

24. The annual numbers of public hospital outpatient visits for all diseases in Guangdong were used for six prefectures (i.e. Shenzhen, Zhuhai, Dongguan, Huizhou, Jiangmen and Zhaoqing) with adjustment according to the proportion of the population sizes of the prefectures.

25. The proportions of the number of public hospital outpatient visits due to cardiovascular and respiratory diseases in the nine prefectures were the same as those for the number of public hospital inpatient episodes in Guangzhou.

26. The annual numbers of private hospital outpatient visits for all diseases in Guangdong province in 2003 were the same as that in 2004.

27. The annual numbers of private hospital outpatient visits for all diseases in Guangdong were used for nine prefectures with adjustment according to the proportion of the population sizes of the prefectures.

28. The proportions of the number of private hospital outpatient visits due to respiratory diseases in the nine prefectures were assumed to be the same as those for the number of public hospital inpatient episodes in Guangzhou.

29. The annual numbers of outpatient visits in public health care centres and other establishments providing health care in MSAR for the two diseases were estimated by the total numbers of outpatient visits adjusted by the proportion of primary health care establishments which were in the public sector.

30. The proportions of A&E visits due to cardiovascular and respiratory diseases in public and private hospitals in MSAR were the same as the public inpatient admissions.

31. The annual number of outpatient visits in private clinics, centres for auxiliary diagnostic examinations and other estab-lishments providing health care in MSAR for the respiratory diseases was estimated by the total number of outpatient visits adjusted by the proportion of primary health care establishments which were in the private sector.

32. The proportions of GOPC, SOPC and A&E visits due to cardiovascular and respiratory diseases in Hong Kong were the same as the public inpatient admissions.

33. Costs of outpatient visits due to cardiovascular diseases were included only for attendances to public hospital outpatients (PRD), public hospital outpatients and other public outpatient clinics (MSAR) and public outpatient clinics (HK). No such costs were assumed to have incurred for visits to private hospital outpatient (PRD), private outpatient clinics except A&E visit in Kiang Wu Hospital (MSAR) and private general practitioners (HK).

34. Excess risks for private GP visits in Hong Kong were applied also to public outpatient visits in Hong Kong and to public and private outpatient visits in PRD and MSAR.

Indirect health care costs (productivity losses)

34. The proportions of the population who aged 15 to 64 in the nine prefectures were the labour force population for the nine prefectures.

35. The proportions of the population who aged 15 to 64 by gender in Dongguan and Jiangmen were the same as that in Guangdong province.

36. The registered urban unemployment rates in the nine prefectures were the same as the real unemployment rates.

37. In estimating the mean monthly income for employed persons in MSAR, those employed persons with unknown monthly earnings were assumed to earn the overall median monthly income of employed population.

38. The annual numbers of public and private hospital episodes for the two main diseases for those aged 15 to 64 in MSAR were estimated by applying the proportion of all discharge episodes in S. Januario Hospital aged 15 to 64 to the total annual numbers of episodes.

39. Productivity losses due to premature deaths were incurred only for the labour force population (aged 15-64) who died before 65 in 2004.


40. In estimating the number of premature deaths, the death rates of the nine prefectures were the same as that in Hong Kong. The average person-years of life lost (PYLL) per death of the nine prefectures was also the same as in Hong Kong.

41. In estimating the PYLL for each death in MSAR, deaths were assumed to have incurred in the middle of the age range at deaths (i.e. 27 for the range 15 to 39 years and 52 for 40 to 64 years). Person-years of life lost were calculated by subtract-ing these approximated age at death from 65 for these premature deaths.

42. The death pattern (age structure of all deaths) in Hong Kong in 2002 was the same as that in 2004.


Table 4.1: Total cost due to PM10

concentrations from 9 monitoring stations in PRD and satellite remote sensing

Area Original value of total costs (RMB) based on real measurements* of PM10

Test value of total costs (RMB) based on satellite inferred concentration+ of PM10

GZ 384,582,902 419,431,955

SZ 23,776,175 40,781,303

ZH 5,850,055 19,559,935

FS 233,210,254 201,666,332

JM 40,332,965 61,611,542

ZQ 39,748,346 52,092,717

HZ 61,433,375 56,148,827

DG 26,657,611 28,783,326

ZS 19,792,973 68,971,576

PRD 835,384,654 949,047,513

* Based on the monthly air pollutant concentrations recorded by the 9 monitoring stations in Guangdong and 10 monitoring stations in Hong Kong.+ The 1-km resolution satellite remote sensing data derived from HKUST were used. PM10 concentrations measured from the monitoring station in Hong Kong were used to regress with the aerosol optical coefficients recorded at the monitor’s geographiclocation so that PM10 concentrations could be inferred from the regression model.


Tabl

e 5.

1: E

stim

ated

att

ribut

able

dea

ths,

hos

pita

l bed

day

s and

out

patie

nt v

isits

in P

RD a

nd M

SAR

for 2

006

pollu

tion

leve

ls

PR

DW

ho

leM

SAR

GZ

SZZ

HFS

JMZQ

HZ

DG

ZS

PR

D

1. D

eath

s

Ann

ual d

eath

s (a

ll ca

uses

, all

ages

)41

,605

2,26

22,

602

14,4

2220

,433

22,4

6112

,843

7,45

18,

409

132,

488

1,53

3

A

ttrib

uted

to P

M10

689

2213

329

245

318

256

132

422,

046

20

A

ttrib

uted

to N

O2

240

300

360

014

40

7654

904

3

A

ttrib

uted

to S

O2

2,99

922

110

1,72

647

21,

436

1754

344

67,

771

7

A

ttrib

uted

to O

30

00

00

00

00

00

A

ttrib

uted

to a

ll 4

pollu

tant

s3,

306

5210

51,

926

642

1,58

327

162

043

98,

944

27

2. B

ed-d

ays

in h

osp

ital

Ann

ual b

ed d

ays f

or c

ardi

ovas

cula

r dis

ease

876,

810

100,

876

150,

618

750,

070

235,

504

240,

703

179,

104

98,9

4136

3,14

52,

995,

771

9,19

6

A

ttrib

uted

to P

M1

22,3

851,

493

1,17

026

,365

4,35

75,

255

5,50

02,

709

2,82

272

,056

181

A

ttrib

uted

to N

O2

5,76

11,

546

021

,355

01,

757

01,

156

2,65

134

,226

22

A

ttrib

uted

to S

O2

50,1

8976

35,

043

71,2

874,

324

12,2

1819

35,

723

15,2

9616

5,03

633

A

ttrib

uted

to O

31,

052

028

90

040

460

234

443

63,

127

0

A

ttrib

uted

to a

ll 4

pollu

tant

s67

,957

2,76

85,

695

95,0

017,

989

16,6

436,

265

8,33

417

,193

227,

845

217

Ann

ual b

ed d

ays f

or re

spira

tory

dis

ease

661,

000

76,0

6011

3,56

056

5,57

017

7,57

018

1,49

013

5,05

074

,600

273,

820

2,25

8,72

019

,339

A

ttrib

uted

to P

M10

16,8

751,

126

882

19,8

803,

285

3,96

24,

147

2,04

32,

128

54,3

2838

0

A

ttrib

uted

to N

O2

4,34

31,

166

016

,102

01,

325

087

21,

999

25,8

0746

A

ttrib

uted

to S

O2

37,8

3657

53,

802

53,7

523,

260

9,21

214

64,

315

11,5

3312

4,43

169

A

ttrib

uted

to O

379

30

218

00

305

454

259

329

2,35

80

A

ttrib

uted

to a

ll 4

pollu

tant

s51

,231

2,08

74,

294

71,6

336,

024

12,5

484,

724

6,28

412

,964

171,

789

456

Att

ribut

able

bed

day

s11

9,18

84,

854

9,98

916

6,63

414

,012

29,1

9110

,988

14,6

1830

,156

399,

630

673


PR

DW

ho

leM

SAR

GZ

SZZ

HFS

JMZQ

HZ

DG

ZS

PR

D

3. O

utp

atie

nt v

isit

s

Ann

ual o

utp

atie

nt v

isits

for

card

iova

scul

ar d

isea

se3,

967,

038

300,

512

156,

820

3,24

8,60

570

1,58

771

7,09

353

3,60

729

4,75

11,

303,

208

11,2

23,2

2121

,059

A

ttrib

uted

to P

M10

897,

820

39,4

2710

,802

1,01

2,26

511

5,06

013

8,77

214

5,26

971

,542

89,7

652,

520,

722

3,66

5

A

ttrib

uted

to N

O2

122,

105

21,5

830

433,

299

024

,525

016

,139

44,5

7066

2,22

123

3

A

ttrib

uted

to S

O2

142,

972

1,43

03,

306

194,

397

8,11

022

,918

363

10,7

3534

,561

418,

792

47

A

ttrib

uted

to O

329

,753

01,

882

00

7,52

911

,206

6,39

79,

774

66,5

410

A

ttrib

uted

to a

ll 4

pollu

tant

s1,

097,

733

49,4

7815

,460

1,35

3,21

112

1,87

317

5,60

815

6,78

093

,574

146,

844

3,21

0,56

13,

800

Ann

ual o

utp

atie

nt v

isits

for

resp

irato

ry d

isea

se4,

958,

370

383,

421

200,

085

4,04

2,29

889

5,15

191

4,93

568

0,82

637

6,07

11,

621,

511

14,0

72,6

6820

,429

A

ttrib

uted

to P

M10

1,12

2,17

850

,305

13,7

821,

259,

580

146,

805

177,

058

185,

348

91,2

8011

1,69

03,

158,

026

3,55

5

A

ttrib

uted

to N

O2

152,

619

27,5

370

539,

162

031

,291

020

,592

55,4

5682

6,65

722

6

A

ttrib

uted

to S

O2

178,

700

1,82

54,

218

241,

891

10,3

4829

,241

463

13,6

9743

,002

523,

385

46

A

ttrib

uted

to O

337

,188

02,

401

00

9,60

714

,297

8,16

212

,161

83,8

160

A

ttrib

uted

to a

ll 4

pollu

tant

s1,

372,

047

63,1

2819

,726

1,68

3,82

515

5,49

722

4,05

720

0,03

411

9,39

018

2,71

04,

020,

414

3,68

6

Att

ribut

able

out

patie

nt v

isits

2,46

9,78

011

2,60

635

,186

3,03

7,03

627

7,37

039

9,66

535

6,81

421

2,96

332

9,55

47,

230,

974

7,48

6

Sour

ce: M

ISSI

NG

Tabl

e 5.

1 (c

ontin

ued)


Table 5.2: Estimated attributable deaths, hospital bed days and outpatient visits in Hong Kong, three estimates

Current analysis Previous estimate based on visibility6

Average to Better visibility

Average to Good visibility

Year 2006 pollutant data

Year 2004 pollutant data

1. Deaths

Annual deaths (non-accidental causes, all ages) 34,619 31,872 31,872

Attributed to PM10

290 281 348

Attributed to NO2

371 545 860

Attributed to SO2

126 127 752

Attributed to O3

na 0 0

Attributed to all 4 pollutants 548 769 1,583

2. Bed days in hospital

Annual bed days for cardiovascular disease 968,301 507,404 507,404

Attributed to PM10

12,492 6,892 8,551

Attributed to NO2

11,850 9,902 15,609

Attributed to SO2

2,797 1,602 9,505

Attributed to O3

0 2,489 4,027

Attributed to all 4 pollutants 19,701 16,758 30,686

Annual bed days for respiratory disease 934,808 546,955 546,955

Attributed to PM10

12,060 10,040 12,456

Attributed to NO2

11,440 7,895 12,447

Attributed to SO2

2,701 1,215 7,210

Attributed to O3

0 6,148 9,948


Attributable bed days 38,720 36,326 64,207

3. Outpatient visits

Annual outpatient visits for cardiovascular disease

1,405,709 1,105,440 1,105,440

Attributed to PM10

160,769 83,054 103,040

Attributed to NO2

80,593 67,369 106,204

Attributed to SO2

2,557 2,745 16,289

Attributed to O3

0 21,822 35,311


Annual outpatient visits for respiratory disease 27,075,887 26,590,693 26,590,693

Attributed to PM10

3,096,635 3,138,011 3,893,135

Attributed to NO2

1,552,328 2,382,818 3,756,402

Attributed to SO2

49,251 52,996 314,498

Attributed to O3

0 802,986 1,299,336

Attributed to all 4 pollutants 3,774,461 4,668,001 7,080,920

Attributable outpatient visits 3,970,421 4,797,427 7,282,002


5.3

: Ann

ual d

irect

, ind

irect

and

tota

l hea

lth ca

re co

sts f

or A

ir Po

llutio

n in

the

PRD

, Mac

ao a

nd H

ong

Kong

bas

ed o

n di

ffere

nces

betw

een

aver

age

2006

and

WH

Ogu

idel

ines

/US

EPA

stan

dard

airp

ollu

tant

leve

ls

PR

D (R

MB

)H

K$

GZ

SZZ

HFS

JMZQ

HZ

DG

ZS

PR

D s

um

PR

D a

vera

ge

Mac

aoH

on

g K

on

g

1. D

irec

t hea

lth

car

e co

st p

er y

ear

du

e to

air

po

lluti

on

PM10

312,

822,

039

13,0

71,3

984,

207,

688

201,

826,

066

29,7

38,4

87

27,4

06,4

64

47,0

92,9

99

14,2

73,5

41

16,4

73,7

13

666

,912

,396

74

,101

,377

5,

329,

038

658

,933

,852

NO

267

,668

,455

7,43

6,11

22,

611,

099

92,1

09,2

61

2,48

4,17

6 5,

531,

644

104,

930

3,5

88,0

10

11,

971,

007

193

,504

,695

21

,500

,522

1,

237,

642

352

,862

,905

SO2

105,

985,

112

1,28

1,58

2 5,

729,

644

91,0

28,9

07

6,57

5,55

2 1

1,97

1,48

3 9

29,3

62

6,31

3,16

9 16

,199

,963

24

6,01

4,77

3 2

7,33

4,97

5 86

7,72

7 2

3,63

6,01

0

O3

19,2

03,0

431,

332,

879

1,6

20,1

61

4,47

2,40

9 1,

657,

237

2,3

12,3

50

4,14

9,74

0 1,

533,

506

3,44

8,94

2 39

,730

,267

4

,414

,474

24

1,14

9 1

5,32

2,53

2

Tota

l 4

pol

luta

nts#

448,

796,

644

18,5

29,6

1211

,711

,301

32

0,52

7,55

3 37

,937

,700

4

2,04

2,83

4 52

,066

,424

22

,581

,193

38

,438

,738

99

2,63

1,99

7 11

0,29

2,44

4 6,

806,

511

838

,784

,424

Ad

just

ed†

1,34

6,95

5,73

6 59

,538

,855

53

,297

,501

1,

280,

872,

706

234,

651,

655

302,

515,

247

263,

155,

071

59,7

33,9

12

166,

354,

150

3,76

7,07

4,83

3 41

8,56

3,87

0 7,

353,

095

838

,784

,424

2. In

dir

ect h

ealt

h c

are

cost

per

yea

r d

ue

to a

ir p

ollu

tio

n

PM10

71,7

60,8

6210

,704

,776

1,64

2,36

631

,384

,188

10,5

94,4

7712

,341

,881

14,3

40,3

7612

,384

,070

3,31

9,26

016

8,47

2,25

818

,719

,140

4,51

3,33

113

4,58

8,14

4

NO

237

,013

,123

14,5

25,7

992,

203,

171

33,3

87,3

912,

063,

067

5,85

2,57

376

,012

7,21

8,76

65,

529,

159

107,

869,

061

11,9

85,4

512,

425,

504

174,

624,

362

SO2

304,

154,

674

12,2

48,8

5013

,964

,079

157,

947,

326

22,3

30,8

0354

,860

,746

3,21

8,00

950

,073

,298

32,8

73,8

5865

1,67

1,64

472

,407

,960

4,90

0,56

161

,327

,567

O3

312,

269

39,8

1154

,846

83,4

9320

,670

37,2

0645

,574

46,1

3099

,011

739,

011

82,1

123,

949

65,8

60

Tota

l 4

pol

luta

nts

342,

738,

438

26,9

89,1

9914

,330

,339

177,

832,

265

30,2

18,8

7960

,861

,669

17,1

20,2

4257

,451

,464

33,2

99,2

6876

0,84

1,76

484

,537

,974

9,62

8,20

725

7,76

5,14

8

Ad

just

ed†

1,02

8,64

7,41

186

,720

,976

65,2

16,6

0371

0,64

2,47

818

6,90

9,32

943

7,92

4,40

586

,529

,443

151,

976,

060

144,

111,

687

2,89

8678

392

322,

075,

377

10,4

01,3

8225

7,76

5,14

8

3. T

ota

l hea

lth

car

e co

st p

er y

ear

du

e to

air

po

lluti

on

PM10

384,

582,

902

23,7

76,1

755,

850,

055

233,

210,

254

40,3

32,9

65

39,

748,

346

61,4

33,3

75

26,6

57,6

11

19,7

92,9

73

835,

384,

654

92,8

20,5

17

9,84

2,36

8 79

3,52

1,99

6

NO

210

4,68

1,57

921

,961

,911

4,81

4,27

012

5,49

6,65

1 4,

547,

243

11,

384,

217

180

,942

1

0,80

6,77

6 1

7,50

0,16

6 3

01,3

73,7

55

33,

485,

973

3,66

3,14

6 52

7,48

7,26

7

SO2

410,

139,

786

13,5

30,4

3119

,693

,723

248,

976,

233

28,9

06,3

55

66,8

32,2

29

4,14

7,37

1 56

,386

,467

49

,073

,822

89

7,68

6,41

7 99

,742

,935

5,

768,

288

84,9

63,5

77

O3

19,5

15,3

121,

372,

690

1,67

5,00

74,

555,

902

1,67

7,90

7 2,

349,

556

4,19

5,31

4 1,

579,

636

3,54

7,95

3 40

,469

,277

4,

496,

586

245,

098

15,3

88,3

92

Tota

l 4

pol

luta

nts

791,

535,

082

45,5

18,8

1126

,041

,640

498,

359,

818

68,1

56,5

79

102,

904,

503

69,1

86,6

66

80,0

32,6

57

71,7

38,0

05

1,75

3,47

3,76

1 19

4,83

0,41

8 16

,434

,718

1,

096,

549,

572

Ad

just

ed†

2,37

5,60

3,14

7 14

6,25

9,83

1 11

8,51

4,10

4 1,

991,

515,

184

421,

560,

983

740,

439,

653

349,

684,

514

211,

709,

972

310,

465,

837

6,66

5,75

3,22

5 74

0,63

9,24

7 17

,754

,477

1,

096,

549,

572

† D

irect

cos

t adj

uste

d by

ratio

of G

DPs

# Th

e su

mm

atio

n al

low

ed fo

r cor

rela

tion

bet

wee

n th

e p

ollu

tant

sv

Sour

ce: H

KU D

epar

tmen

t of C

omm

unit

y M

edic

ine

v.

The

tota

l for

all

4 p

ollu

tant

s w

as c

alcu

late

d by

the

adju

sted

sum

mat

ion

(T1)

met

hod

outl

ined

in th

e fu

ll H

KU re

por

t.


Tabl

e 5.

4: C

osts

per

one

mill

ion

popu

latio

n fo

r air

pollu

tion

in th

e PR

D, M

acao

, and

Hon

g Ko

ng b

ased

on

diffe

renc

esbe

twee

nav

erag

e20

06an

dW

HO

guid

elin

es/U

SEP

Ast

anda

rdai

rpol

luta

ntle

vels

PR

D (R

MB

)H

K$

GZ

SZZ

HFS

JMZQ

HZ

DG

ZS

PR

D s

um

*P

RD

av

erag

eM

acao

Ho

ng

Ko

ng

1. D

irec

t hea

lth

car

e co

st p

er y

ear

du

e to

air

po

lluti

on

PM10

42,

932,

067

7,91

5,60

2 4

,882

,744

5

7,51

8,36

2 7

,713

,666

6

,955

,060

1

6,06

0,47

2 8

,812

,514

1

1,81

3,77

1 1

64,6

04,2

60

18,

289,

362

11,

518,

832

97,

137,

739

NO

2 9

,330

,714

4

,503

,061

3

,029

,995

2

6,25

0,19

6 6

44,3

54

1,4

03,7

90

35,

785

2,2

15,2

45

8,5

84,7

52

55,

997,

892

6,2

21,9

88

2,6

75,1

90

52,

017,

823

SO2

15,

259,

409

776

,083

6

,648

,773

2

5,94

2,30

6 1

,705

,588

3

,038

,056

3

16,9

47

3,8

97,7

64

11,

617,

457

69,

202,

384

7,6

89,1

54

1,8

75,6

11

3,4

84,3

38

O3

2,6

59,0

29

807

,147

1

,880

,089

1

,274

,591

4

29,8

60

586

,815

1

,415

,216

9

46,7

90

2,4

73,3

35

12,

475,

872

1,3

85,8

75

521

,249

2

,258

,794

Tota

l 4

pol

luta

nts#

62,

234,

593

11,

220,

914

13,

590,

101

91,

347,

071

9,8

40,4

04

10,

669,

397

17,

756,

596

13,

941,

676

27,

565,

519

258

,166

,270

2

8,68

5,14

1 1

4,71

2,42

2 1

23,6

50,6

85

Ad

just

ed†

186

,782

,240

3

6,05

4,74

3 6

1,84

7,81

9 3

65,0

35,6

06

60,

864,

710

76,

770,

641

89,

745,

713

36,

879,

842

119

,297

,321

1,0

33,2

78,6

34 1

14,8

08,7

37

15,

893,

875

123

,650

,685

2. In

dir

ect h

ealt

h c

are

cost

per

yea

r d

ue

to a

ir p

ollu

tio

n

PM10

9,72

8,01

86,

482,

455

1,90

5,87

08,

944,

172

2,74

8,03

03,

132,

054

4,89

0,60

47,

645,

951

2,38

0,33

647

,857

,490

5,31

7,49

99,

755,

663

19,8

40,5

16

NO

25,

017,

558

8,79

6,33

92,

556,

651

9,51

5,06

453

5,12

51,

485,

234

25,9

234,

456,

881

3,96

5,11

836

,353

,893

4,03

9,32

15,

242,

780

25,7

42,5

17

SO2

41,2

31,6

967,

417,

494

16,2

04,4

9645

,013

,371

5,79

2,23

613

,922

,256

1,09

7,46

130

,915

,359

23,5

74,7

8518

5,16

9,15

420

,574

,350

10,5

92,6

699,

040,

697

O3

42,3

3224

,108

63,6

4623

,795

5,36

19,

442

15,5

4328

,481

71,0

0428

3,71

131

,523

8,53

59,

709

Tota

l 4

pol

luta

nts#

46,4

62,1

7316

,343

,758

16,6

29,5

2050

,680

,375

7,83

8,27

115

,445

,137

5,83

8,64

235

,470

,654

23,8

79,8

5821

8,58

8,38

724

,287

,599

20,8

11,5

8037

,998

,842

Ad

just

ed†

139,

445,

094

52,5

15,3

2775

,680

,051

202,

525,

830

48,4

81,1

5011

1,13

4,02

529

,509

,773

93,8

30,3

3810

3,34

6,61

585

6,46

8,20

495

,163

,134

22,4

82,8

1537

,998

,842

3. T

ota

l hea

lth

car

e co

st p

er y

ear

du

e to

air

po

lluti

on

PM10

52,

660,

085

14,

398,

058

6,7

88,6

14

66,

462,

534

10,

461,

696

10,

087,

115

20,

951,

076

16,

458,

465

14,

194,

108

212

,461

,750

2

3,60

6,86

1 21

,274

,495

11

6,97

8,25

5

NO

2 1

4,34

8,27

2 1

3,29

9,40

0 5

,586

,646

3

5,76

5,26

1 1

,179

,479

2

,889

,024

6

1,70

8 6

,672

,126

1

2,54

9,87

0 9

2,35

1,78

5 1

0,26

1,30

9 7,

917,

969

77,7

60,3

40

SO2

56,

491,

105

8,1

93,5

77

22,

853,

269

70,

955,

677

7,4

97,8

24

16,

960,

312

1,4

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08

34,

813,

123

35,

192,

242

254

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8,26

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4 12

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98

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Table 6.1: Sensitivity analysis on combination of 4 air pollutants

Baseline model

Test model Area Original value of total costs (RMB/ HK$) based on T1

Test value of total costs (RMB/ HK$)

T11 T22 GZ 791,535,082 918,919,579

SZ 45,518,811 60,641,207

ZH 26,041,640 32,033,055

FS 498,359,818 612,239,040

JM 68,156,579 75,464,469

ZQ 102,904,503 120,314,348

HZ 69,186,666 69,957,001

DG 80,032,657 95,430,489

ZS 71,738,005 89,914,915

PRD 1,753,473,761 2,074,914,103

M 16,434,718 19,518,900

HK 1,096,549,572 1,421,361,232

T11 T33 GZ 791,535,082 800,539,342

SZ 45,518,811 42,634,348

ZH 26,041,640 28,009,202

FS 498,359,818 497,661,120

JM 68,156,579 67,486,916

ZQ 102,904,503 107,689,436

HZ 69,186,666 62,460,146

DG 80,032,657 84,774,901

ZS 71,738,005 75,464,643

PRD 1,753,473,761 1,766,720,054

M 16,434,718 15,810,245

HK 1,096,549,572 962,172,379

T11 T44 GZ 791,535,082 608,709,866

SZ 45,518,811 44,419,465

ZH 26,041,640 23,950,594

FS 498,359,818 424,061,444

JM 68,156,579 46,458,080

ZQ 102,904,503 82,142,184

HZ 69,186,666 35,746,137

DG 80,032,657 66,938,763

ZS 71,738,005 66,958,254

PRD 1,753,473,761 1,399,384,786

M 16,434,718 12,761,949

HK 1,096,549,572 971,618,460

1 T1 = PM10

+ 0.41(NO2) + 0.84(SO

2) + O

3

2 T2 = PM10

+ SO2+ NO

2+ O

3

3 T3 = SO2 + 0.88 PM

10 + 0.31 NO

2 + O

3

4 T4 = NO2 + 0.75 SO

2 + 0.46 PM

10 + O

3



Baseline model



T11 T55 GZ 791,535,082 432,752,076

SZ 45,518,811 27,605,117

ZH 26,041,640 20,472,158

FS 498,359,818 265,025,808

JM 68,156,579 43,370,771

ZQ 102,904,503 67,413,910

HZ 69,186,666 61,433,375

DG 80,032,657 56,386,467

ZS 71,738,005 49,247,741

PRD 1,753,473,761 1,023,707,421

M 16,434,718 10,367,050

HK 1,096,549,572 793,521,996

T11 T66 GZ 791,535,082 432,752,076

SZ 45,518,811 27,605,117

ZH 26,041,640 20,472,158

FS 498,359,818 265,025,808

JM 68,156,579 43,370,771

ZQ 102,904,503 67,413,910

HZ 69,186,666 61,433,375

DG 80,032,657 56,386,467

ZS 71,738,005 49,247,741

PRD 1,753,473,761 1,023,707,421

M 16,434,718 10,367,050

HK 1,096,549,572 793,521,996

T11 T77 GZ 791,535,082 452,267,388

SZ 45,518,811 28,977,807

ZH 26,041,640 22,147,165

FS 498,359,818 269,581,710

JM 68,156,579 45,048,678

ZQ 102,904,503 69,763,465

HZ 69,186,666 65,628,688

DG 80,032,657 57,966,103

ZS 71,738,005 52,621,775

PRD 1,753,473,761 1,064,002,779

M 16,434,718 10,612,148

HK 1,096,549,572 808,910,388

5 T5 = Max (PM10

, NO2, SO

2, O

3)

6 T6 = PM10

+ O3

7 T7 =Max (PM10

, NO2, SO

2) + O

3



Baseline model



T11 T88 GZ 791,535,082 410,139,786

SZ 45,518,811 13,530,431

ZH 26,041,640 19,693,723

FS 498,359,818 248,976,233

JM 68,156,579 28,906,355

ZQ 102,904,503 66,832,229

HZ 69,186,666 4,147,371

DG 80,032,657 56,386,467

ZS 71,738,005 49,073,822

PRD 1,753,473,761 897,686,417

M 16,434,718 5,768,288

HK 1,096,549,572 84,963,577

8 T8 = SO2

Table 6.2: Sensitivity analysis on WHO guideline values

Baseline model

Test model Area Original value of total costs (RMB/ HK$)


WHO guideline values

Half of the WHO guideline values

GZ 791,535,082 990,397,365

SZ 45,518,811 73,302,477

ZH 26,041,640 80,335,868

FS 498,359,818 582,257,226

JM 68,156,579 92,378,488

ZQ 102,904,503 132,117,731

HZ 69,186,666 88,848,582

DG 80,032,657 91,643,497

ZS 71,738,005 101,635,091

PRD 1,753,473,761 2,232,916,325

M 16,434,718 21,989,201

HK 1,096,549,572 1,836,774,520


Table 6.3: Sensitivity analysis on effects of PRD air data on the HK model

Baseline model

Test model PRD air data Original value of total costs (RMB/ HK$)


Use the PRD air pollutant data for the PRD model

Use the PRD air pollutant data for the HK model

GZ 791,535,082 3,180,133,914

SZ 45,518,811 1,451,612,478

ZH 26,041,640 1,547,808,579

FS 498,359,818 4,924,640,968

JM 68,156,579 1,702,588,005

ZQ 102,904,503 2,729,923,423

HZ 69,186,666 2,114,783,662

DG 80,032,657 3,123,971,517

ZS 71,738,005 1,737,214,637

PRD 1,753,473,761 2,428,517,864

Table 6.4: Sensitivity analysis on total numbers of bed-days in private hospitals in PRD

Baseline model

Test model Area Original value of direct costs (RMB/ HK$)

Test value of direct costs (RMB/ HK$)

See note9 See note10 GZ 191,719,590 195,643,993

SZ 6,115,978 6,228,298

ZH 8,423,809 8,800,742

FS 151,900,619 156,854,107

JM 16,143,201 16,492,682

ZQ 20,775,630 21,207,170

HZ 14,893,215 15,170,018

DG 11,563,138 11,821,557

ZS 23,003,155 23,839,414

PRD 444,538,335 456,057,982

HK 191,719,590 195,643,993

9Average LOS for 2 main diseases in public General hospitals in Guangzhou * Total numbers of private hospital inpatients in Guangdong * Proportion of population of each prefecture to Guangdong.10The proportions of number of bed-days in public and private sectors in Hong Kong (HA Annual Report 2000/01) were applied to the 9 prefectures in PRD.


Table 6.5: Sensitivity analysis on proportion of hospital inpatients for each disease in PRD

Baseline model

Test model Area Original value of direct costs (RMB/ HK$)

Test value of direct costs (RMB/ HK$)

See note11 Sensitivity a:See note12

GZ 448,796,644 448,796,644

SZ 18,529,612 17,309,291

ZH 11,711,301 11,711,301

FS 320,527,553 320,527,553

JM 37,937,700 37,937,700

ZQ 42,042,834 42,042,834

HZ 52,066,424 52,066,424

DG 22,581,193 22,581,193

ZS 38,438,737 38,438,737

PRD 992,631,997 991,411,677

See note11 Sensitivity b:See note13

GZ 448,796,644 448,796,644

SZ 18,529,612 17,309,291

ZH 11,711,301 11,167,824

FS 320,527,553 308,657,949

JM 37,937,700 36,676,105

ZQ 42,042,834 40,520,243

HZ 52,066,424 50,634,681

DG 22,581,193 21,746,787

ZS 38,438,737 36,853,687

PRD 992,631,997 972,363,211

11 No. of discharges for each of the 2 main diseases in Guangzhou / Total no. of discharges for all diseases in Guangzhou12 No. of discharges for 2 main diseases in Shenzhen and Guangzhou were obtained and were used in Shenzhen’s and Guangzhou’s model respectively. No. of discharges for the 2 main diseases in other 7 prefectures were assumed to be the same as Guangzhou.13 No. of discharges for the 2 main diseases in Shenzhen and Guangzhou were obtained and were used in Shenzhen’s and Guangzhou’s model respectively. No. of discharges for each of the 2 main diseases in other 7 prefectures were estimated as: (No. of hospital inpatients of all diseases for each prefecture) * (No. of discharges for each of the 2 main diseases in Guangzhou and Shenzhen) / (Total no. of discharges for all diseases in Guangzhou and Shenzhen)

Table 6.6: Sensitivity analysis on average cost per bed-day in public hospitals

Baseline model Test model Area Original value of direct costs (RMB) Test value of direct costs (RMB)


SZ 6,115,978 5,985,864

ZH 8,423,809 8,492,023

FS 151,900,619 152,150,247

JM 16,143,201 15,361,055

ZQ 20,775,630 19,719,063

HZ 14,893,215 14,076,010

DG 11,563,138 11,765,091

ZS 23,003,155 23,651,431

PRD 444,538,335 421,386,630

14 Average cost per bed-day in non-profit General hospitals in each of the 9 prefectures.15 Weighted average cost per bed-day in non-profit General and non-profit TCM hospitals in each of the 9 prefectures. [(No. ofGeneral hospitals * Average cost per bed-day in General hospitals) + (No. of TCM hospitals * Average cost per bed-day in TCM hospitals)] / Total no. of General hospitals and TCM hospitals


Table 6.7: Sensitivity analysis on average cost of an inpatient episode in Shenzhen

Baseline model

Test model Area Original value of direct costs (RMB)

Test value of direct costs (RMB)

See note16 See note17 SZ 6,115,978 5,331,697

16Average LOS for 2 main diseases in GZ * Average cost per bed-day in non-profit General hospitals in SZ17 Average cost per discharge episode for 2 main diseases in SZ

Table 6.8: Sensitivity analysis on number of hospital inpatients for employed population aged 15 to 64 in 9 prefectures of PRD

Baseline model

Test model Area Original value of productivity loss on hospital episodes (RMB)

Test value of productivity loss on hospital episodes (RMB)


SZ 429,358 132,034

ZH 463,717 165,738

FS 6,692,409 2,343,789

JM 417,292 161,982

ZQ 726,228 315,088

HZ 373,659 139,666

DG 704,860 275,489

ZS 1,469,016 503,032

PRD 19,078,855 6,842,721

18 No. of episodes of the 2 main diseases (all ages)* Proportion of the population aged 15-64 * Employment rate19 No. of episodes of the 2 main diseases (all ages) * Proportion of hospital inpatients aged 15-59 for each disease in GZ * Employment rate

Table 6.9: Sensitivity analysis on use of mean and median monthly income for males and females in HK and MSAR

Baseline model

Test model Area Original value of total costs based on T1 (HK$)

Test value of total costs ( HK$)

See note20 See note21 HK 1,096,549,572 1,002,939,112

M 16,434,718 13,033,032

20 Mean monthly income for males and females 21 Median monthly income for males and females (HK); for overall (M)

60Appendices

61Appendices

Tabl

e A

.1.1

a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3 c

hang

e ai

r pol

luta

nt(s

) in

Gua

ngzh

ou

Hea

lth

car

e co

st (R

MB

) per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (R

MB

) per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

—Pu

blic

C

ardi

ovas

cula

r dis

ease

s13

,185

52,5

7517

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6,

916,

043

39,8

67,1

86

1,40

0,30

8 55

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Re

spira

tory

dis

ease

s8,

040

65,0

0118

,138

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3,

856,

785

21,1

49,6

08

2,41

9,20

1 39

,904

,717

Co

st fo

r it

em (a

):35

,943

,387

10

,772

,828

61

,016

,794

3,

819,

509

95,4

33,8

62

(b) H

osp

ital

inp

atie

nts

—Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s13

,185

889

301,

051

116,

939

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089

23,6

77

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907

Re

spira

tory

dis

ease

s8,

040

1,09

930

6,75

4 65

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35

7,67

6 40

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67

4,85

7

Co

st fo

r it

em (b

):60

7,80

5 18

2,16

4 1,

031,

765

64,5

90

1,61

3,76

5

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tpat

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ts—

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lic

C

ardi

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s13

63,

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5 15

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6 19

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9,80

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0

(d) H

osp

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tpat

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ate

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spira

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dis

ease

s13

652

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1,52

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3,21

7 24

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Co

st fo

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525,

786

313,

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1

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are

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Ap

pen

dix

1: D

etai

led

tab

les

on d

irec

t an

d in

dir

ect h

ealt

h c

are

cost

due

to a

ir p

ollu

tion

62Appendices

Tabl

e A

.1.1

b: P

rodu

ctiv

ity lo

ss (P

L) d

ue to

per

10

µg /m

3 ch

ange

in a

ir po

lluta

nt(s

) lev

el in

Gua

ngzh

ou

PL

(RM

B) p

er y

ear

du

e to

air

po

lluti

on

PL

(RM

B) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

- Pu

blic

C

ardi

ovas

cula

r dis

ease

s1,

394

39,9

801,

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450

556,

028

3,20

5,19

3 11

2,58

0 4,

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364

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spira

tory

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3 1,

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1

Co

st fo

r it

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):2,

889,

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866,

101

4,90

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4 30

7,07

6 7,

672,

575

(b) H

osp

ital

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atie

nts

- Pr

ivat

e

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ardi

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r dis

ease

s1,

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ease

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9 54

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98,2

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62,2

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5,15

8—

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13,0

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Co

st fo

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32,3

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9,16

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0—

334,

936,

122

Tota

l pro

du

ctiv

ity

loss

(in

dir

ect h

ealt

h c

are

cost

):

71,7

60,8

6237

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304,

154,

674

312,

269

342,

738,

438

Tota

l dir

ect a

nd

ind

irec

t hea

lth

car

e co

st:

3

84,5

82,9

02

10

4,68

1,57

9 4

10,1

39,7

86

19,

515,

312

791,

535,

082

63Appendices

Tabl

e A

.1.2

a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) i

n Sh

enzh

en

Hea

lth

car

e co

st (R

MB

) per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (R

MB

) per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

—Pu

blic

C

ardi

ovas

cula

r dis

ease

s9,

663

5,95

2

849,

348

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1

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37,5

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spira

tory

dis

ease

s5,

892

7,36

0

865,

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480

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1

88,8

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1,4

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29

Co

st fo

r it

em (a

):

1

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6,35

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298

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(b) H

osp

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ivat

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s9,

663

199

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spira

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dis

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246

2

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90

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st fo

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):

57,

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ovas

cula

r dis

ease

s12

630

0,51

2

4,9

64,7

64

2

,658

,585

210,

583

450,

302

6,68

1,97

6

Re

spira

tory

dis

ease

s12

637

1,61

1

6,1

39,3

93

3

,287

,587

260,

406

556,

841

8,26

2,88

5

Co

st fo

r it

em (c

):11

,104

,157

5,

946,

172

470,

990

1,00

7,14

3 14

,944

,862

(d) H

osp

ital

ou

tpat

ien

ts—

Priv

ate

Re

spira

tory

dis

ease

s12

611

,810

195

,118

1

04,4

84

8,27

6

1

7,69

7

262,

605

Co

st fo

r it

em (d

):

1

95,1

18

104

,484

8,

276

17,

697

26

2,60

5

Tota

l dir

ect h

ealt

h c

are

cost

: 1

3,07

1,39

8

7,4

36,1

12

1,28

1,58

2

1,33

2,87

9

18,

529,

612

64Appendices

Tabl

e A

.1.2

b: P

rodu

ctiv

ity lo

ss (P

L) d

ue to

per

10

µg /m

3 ch

ange

in a

ir po

lluta

nt(s

) lev

el in

She

nzhe

n

PL

(RM

B) p

er y

ear

du

e to

air

po

lluti

on

PL

(RM

B) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

- Pu

blic

C

ardi

ovas

cula

r dis

ease

s1,

429

5,20

0 1

09,7

71

111

,226

6

5,55

4 1

4,12

2 2

24,5

60

Re

spira

tory

dis

ease

s87

16,

431

111

,850

6

2,03

8 3

4,78

3 2

4,40

2 1

90,9

06

Co

st fo

r it

em (a

): 2

21,6

21

173

,265

1

00,3

37

38,

523

415

,466

(b) H

osp

ital

inp

atie

nts

- Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s1,

429

174

3,6

70

3,7

19

2,1

92

472

7

,508

Re

spira

tory

dis

ease

s87

121

5 3

,740

2

,074

1

,163

8

16

6,3

83

Co

st fo

r it

em (b

): 7

,410

5

,793

3

,355

1

,288

1

3,89

2

(c) P

rem

atu

re d

eath

Fe

mal

e31

,808

3,38

9,88

24,

642,

511

3,93

0,09

3—

8,59

4,58

9

M

ale

31,8

087,

085,

863

9,70

4,23

08,

215,

065

—17

,965

,252

Co

st fo

r it

em (c

):10

,475

,745

14,3

46,7

4112

,145

,158

—26

,559

,841

Tota

l pro

du

ctiv

ity

loss

(in

dir

ect h

ealt

h c

are

cost

):

10,7

04,7

7614

,525

,799

12,2

48,8

5039

,811

26,9

89,1

99

Tota

l dir

ect a

nd

ind

irec

t hea

lth

car

e co

st:

23,

776,

175

21,

961,

911

13,

530,

431

1,3

72,6

90

45,

518,

811

65Appendices

Tabl

e A

.1.3

a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) i

n Zh

uhai

Hea

lth

car

e co

st (R

MB

) per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (R

MB

) per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

—Pu

blic

C

ardi

ovas

cula

r dis

ease

s9,

878

9,08

068

5,85

5 69

8,41

2 3,

115,

947

287,

019

3,87

6,61

9

Re

spira

tory

dis

ease

s6,

023

11,2

2869

8,85

0 38

9,55

2 1,

653,

343

495,

958

2,74

3,33

2

Co

st fo

r it

em (a

):1,

384,

705

1,08

7,96

5 4,

769,

290

782,

976

6,61

9,95

0

(b) H

osp

ital

inp

atie

nts

—Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s9,

878

104

7,84

4 7,

988

35,6

37

3,28

3 44

,337

Re

spira

tory

dis

ease

s6,

023

128

7,99

3 4,

455

18,9

09

5,67

2 31

,376

Co

st fo

r it

em (b

):15

,837

12

,443

54

,547

8,

955

75,7

13

(c) H

osp

ital

ou

tpat

ien

ts a

nd

A

&E

visi

ts—

Pub

lic

C

ardi

ovas

cula

r dis

ease

s11

615

6,82

0

1,23

3,42

6

663,

779

39

8,00

1

363

,914

2,20

3,81

0

Re

spira

tory

dis

ease

s11

619

3,92

2

1,52

5,24

6

820,

825

49

2,16

5

450

,014

2,72

5,21

6

Co

st fo

r it

em (c

):2,

758,

672

1,48

4,60

4 89

0,16

6 81

3,92

8 4,

929,

027

(d) H

osp

ital

ou

tpat

ien

ts—

Priv

ate

Re

spira

tory

dis

ease

s11

66,

163

48,

474

2

6,08

7

15,

642

14,3

02

86,

611

Co

st fo

r it

em (d

):

4

8,47

4

26,

087

1

5,64

2

14

,302

8

6,61

1

Tota

l dir

ect h

ealt

h c

are

cost

:

4,20

7,68

8

2,

611,

099

5,72

9,64

4 1

,620

,161

1

1,71

1,30

1

66Appendices

Tabl

e A

.1.3

b: P

rodu

ctiv

ity lo

ss (P

L) d

ue to

per

10

µg /m

3 ch

ange

in a

ir po

lluta

nt(s

) lev

el in

Zhu

hai

PL

(RM

B) p

er y

ear

du

e to

air

po

lluti

on

PL

(RM

B) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

- Pu

blic

C

ardi

ovas

cula

r dis

ease

s90

06,

903

47,5

00

48,3

69

215,

799

19,8

78

268,

480

Re

spira

tory

dis

ease

s54

98,

536

48,4

00

26,9

79

114,

504

34,3

48

189,

993

Co

st fo

r it

em (a

):95

,899

75

,348

33

0,30

3 54

,226

45

8,47

3

(b) H

osp

ital

inp

atie

nts

- Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s90

079

543

553

2,46

8 22

7 3,

071

Re

spira

tory

dis

ease

s54

998

554

309

1,31

0 39

3 2,

173

Co

st fo

r it

em (b

):1,

097

862

3,77

8 62

0 5,

244

(c) P

rem

atu

re d

eath

Fe

mal

e20

,027

506,

862

697,

616

4,47

0,46

5—

4,54

8,07

5

M

ale

20,0

271,

038,

508

1,42

9,34

59,

159,

533

—9,

318,

547

Co

st fo

r it

em (c

):1,

545,

370

2,12

6,96

113

,629

,998

—13

,866

,622

Tota

l pro

du

ctiv

ity

loss

(in

dir

ect h

ealt

h c

are

cost

):

1,64

2,36

62,

203,

171

13,9

64,0

7954

,846

14,3

30,3

39

Tota

l dir

ect a

nd

ind

irec

t hea

lth

car

e co

st:

5,

850,

055

4,81

4,27

0

19,

693,

723

1,

675,

007

26,

041,

640

67Appendices

Tabl

e A

.1.4

a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) i

n Fo

shan

Hea

lth

car

e co

st (R

MB

) per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (R

MB

) per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

—Pu

blic

C

ardi

ovas

cula

r dis

ease

s8,

640

45,3

1313

,761

,414

11

,169

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37

,279

,141

38

3,67

5 50

,039

,256

Re

spira

tory

dis

ease

s5,

268

56,0

3414

,022

,142

6,

230,

259

19,7

80,5

69

662,

977

33,8

55,2

03

Co

st fo

r it

em (a

):27

,783

,556

17

,400

,233

57

,059

,709

1,

046,

652

83,8

94,4

59

(b) H

osp

ital

inp

atie

nts

—Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s8,

640

423

128,

419

104,

236

347,

881

3,58

0 46

6,95

6

Re

spira

tory

dis

ease

s5,

268

523

130,

852

58,1

39

184,

588

6,18

7 31

5,93

0

Co

st fo

r it

em (b

):25

9,27

0 16

2,37

5 53

2,46

9 9,

767

782,

886

(c) H

osp

ital

ou

tpat

ien

ts a

nd

A

&E

visi

ts—

Pub

lic

C

ardi

ovas

cula

r dis

ease

s76

3,24

8,60

5

77,

432,

538

3

3,21

5,72

6

14,

898,

391

1,52

2,06

1 1

05,0

87,6

96

Re

spira

tory

dis

ease

s76

4,01

7,20

3

95,

752,

539

4

1,07

4,33

6

18,

423,

247

1,88

2,17

0 1

29,9

50,7

15

Co

st fo

r it

em (c

): 1

73,1

85,0

77

74,2

90,0

62

33,3

21,6

39

3,40

4,23

2 23

5,03

8,41

1

(d) H

osp

ital

ou

tpat

ien

ts—

Priv

ate

Re

spira

tory

dis

ease

s76

25,0

95

598

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256,

590

11

5,08

9

11,

758

81

1,79

7

Co

st fo

r it

em (d

):

598

,163

256,

590

11

5,08

9

11,

758

81

1,79

7

Tota

l dir

ect h

ealt

h c

are

cost

:

201,

826,

066

9

2,10

9,26

1

91,

028,

907

4,47

2,40

9 3

20,5

27,5

53

68Appendices

Tabl

e A

.1.4

b: P

rodu

ctiv

ity lo

ss (P

L) d

ue to

per

10

µg /m

3 ch

ange

in a

ir po

lluta

nt(s

) lev

el in

Fos

han

PL

(RM

B) p

er y

ear

du

e to

air

po

lluti

on

PL

(RM

B) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

- Pu

blic

C

ardi

ovas

cula

r dis

ease

s87

035

,555

1,08

7,62

3 88

2,81

0 2,

946,

328

30,3

23

3,95

4,81

4

Re

spira

tory

dis

ease

s53

143

,966

1,10

8,22

9 49

2,40

4 1,

563,

342

52,3

98

2,67

5,71

9

Co

st fo

r it

em (a

):2,

195,

852

1,37

5,21

4 4,

509,

670

82,7

21

6,63

0,53

4

(b) H

osp

ital

inp

atie

nts

- Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s87

033

210

,149

8,

238

27,4

95

283

36,9

06

Re

spira

tory

dis

ease

s53

141

010

,342

4,

595

14,5

89

489

24,9

69

Co

st fo

r it

em (b

):20

,491

12

,833

42

,083

77

2 61

,875

(c) P

rem

atu

re d

eath

Fe

mal

e19

,369

9,17

7,19

910

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48,2

63,4

78—

53,8

46,4

35

M

ale

19,3

6919

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21,9

31,2

5910

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2,09

4—

117,

293,

422

Co

st fo

r it

em (c

):29

,167

,845

31,9

99,3

4315

3,39

5,57

3—

171,

139,

857

Tota

l pro

du

ctiv

ity

loss

(in

dir

ect h

ealt

h c

are

cost

):

31,3

84,1

8833

,387

,391

157,

947,

326

83,4

9317

7,83

2,26

5

Tota

l dir

ect a

nd

ind

irec

t hea

lth

car

e co

st:

2

33,2

10,2

54

12

5,49

6,65

1

248,

976,

233

4,

555,

902

498,

359,

818

69Appendices

Tabl

e A

.1.5

a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) i

n Ji

angm

en

Hea

lth

car

e co

st (R

MB

) per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (R

MB

) per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

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ER

(a) H

osp

ital

inp

atie

nts

—Pu

blic

C

ardi

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cula

r dis

ease

s10

,541

13,8

952,

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041

2,96

5,93

6 18

1,61

8 5,

529,

814

Re

spira

tory

dis

ease

s6,

427

17,1

822,

747,

153

218,

668

1,57

3,74

6 31

3,82

9 4,

472,

582

Co

st fo

r it

em (a

):5,

443,

226

610,

709

4,53

9,68

2 49

5,44

7 10

,002

,396

(b) H

osp

ital

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atie

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e

C

ardi

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r dis

ease

s10

,541

465

90,1

47

13,1

08

99,1

70

6,07

3 18

4,89

7

Re

spira

tory

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ease

s6,

427

575

91,8

55

7,31

1 52

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14

9,54

7

Co

st fo

r it

em (b

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2,00

1 20

,420

15

1,79

0 16

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33

4,44

3

(c) H

osp

ital

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ts a

nd

A

&E

visi

ts—

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lic

C

ardi

ovas

cula

r dis

ease

s93

701,

587

10,

595,

074

814

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8

27,8

42

503

,198

1

2,12

7,48

3

Re

spira

tory

dis

ease

s93

867,

578

13,

101,

794

1,0

06,8

42

1,0

23,7

03

622

,251

1

4,99

6,76

1

Co

st fo

r it

em (c

): 2

3,69

6,86

8 1

,821

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1

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1

,125

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2

7,12

4,24

4

(d) H

osp

ital

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ts—

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ate

Re

spira

tory

dis

ease

s93

27,5

73 4

16,3

92

31,

999

32,

535

19,

776

476

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Co

st fo

r it

em (d

): 4

16,3

92

31,

999

32,

535

19,

776

476

,616

Tota

l dir

ect h

ealt

h c

are

cost

: 2

9,73

8,48

7 2

,484

,176

6

,575

,552

1

,657

,237

3

7,93

7,70

0

70Appendices

Tabl

e A

.1.5

b: P

rodu

ctiv

ity lo

ss (P

L) d

ue to

per

10

µg /m

3 ch

ange

in a

ir po

lluta

nt(s

) lev

el in

Jian

gmen

PL

(RM

B) p

er y

ear

du

e to

air

po

lluti

on

PL

(RM

B) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

- Pu

blic

C

ardi

ovas

cula

r dis

ease

s61

39,

639

108,

839

15,8

26

119,

733

7,33

2 22

3,23

6

Re

spira

tory

dis

ease

s37

412

,246

110,

901

8,82

8 63

,531

12

,669

18

0,55

6

Co

st fo

r it

em (a

):21

9,74

0 24

,654

18

3,26

5 20

,001

40

3,79

1

(b) H

osp

ital

inp

atie

nts

- Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s61

332

23,

639

529

4,00

3 24

5 7,

464

Re

spira

tory

dis

ease

s37

439

93,

708

295

2,12

4 42

4 6,

037

Co

st fo

r it

em (b

):21

9,74

0 24

,654

18

3,26

5 20

,001

40

3,79

1

(c) P

rem

atu

re d

eath

Fe

mal

e13

,653

3,38

0,29

166

4,35

67,

219,

214

—9,

716,

817

M

ale

13,6

536,

987,

099

1,37

3,23

214

,922

,197

—20

,084

,770

Co

st fo

r it

em (c

):10

,367

,390

2,03

7,58

922

,141

,411

—29

,801

,587

Tota

l pro

du

ctiv

ity

loss

(in

dir

ect h

ealt

h c

are

cost

):

10,5

94,4

772,

063,

067

22,3

30,8

0320

,670

30,2

18,8

79

Tota

l dir

ect a

nd

ind

irec

t hea

lth

car

e co

st:

40,

332,

965

4,54

7,24

3

28,

906,

355

1,

677,

907

68,

156,

579

71Appendices

Tabl

e A

.1.6

a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) i

n Zh

aoqi

ng

Hea

lth

car

e co

st (R

MB

) per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (R

MB

) per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

—Pu

blic

C

ardi

ovas

cula

r dis

ease

s7,

291

14,2

022,

241,

360

793,

718

5,20

0,32

8 23

1,95

4 7,

167,

014

Re

spira

tory

dis

ease

s4,

446

17,5

622,

283,

825

442,

711

2,75

9,32

9 40

0,80

8 5,

183,

981

Co

st fo

r it

em (a

):4,

525,

185

1,23

6,42

9 7,

959,

657

632,

762

12,3

50,9

95

(b) H

osp

ital

inp

atie

nts

—Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s7,

291

475

74,9

43

26,5

39

173,

880

7,75

6 23

9,63

9

Re

spira

tory

dis

ease

s4,

446

587

76,3

63

14,8

03

92,2

62

13,4

02

173,

333

Co

st fo

r it

em (b

):15

1,30

6 41

,342

26

6,14

2 21

,157

41

2,97

2

(c) H

osp

ital

ou

tpat

ien

ts a

nd

A

&E

visi

ts—

Pub

lic

C

ardi

ovas

cula

r dis

ease

s73

717,

093

9

,987

,274

1,8

69,1

01

1,64

5,80

8

72

8,69

4

12,8

64,7

78

Re

spira

tory

dis

ease

s73

886,

753

12

,350

,194

2,3

11,3

17

2,03

5,19

5

90

1,09

8

15,9

08,4

96

Co

st fo

r it

em (c

):

22,

337,

468

4

,180

,417

3,6

81,0

02

1,62

9,79

2

28

,773

,274

(d) H

osp

ital

ou

tpat

ien

ts—

Priv

ate

Re

spira

tory

dis

ease

s73

28,1

82

3

92,5

05

7

3,45

7

64,

681

28,

638

505

,592

Co

st fo

r it

em (d

):

3

92,5

05

7

3,45

7

64,

681

28,

638

505

,592

Tota

l dir

ect h

ealt

h c

are

cost

:

27,4

06,4

64

5

,531

,644

11,

971,

482

2,

312,

350

42

,042

,834

72Appendices

Tabl

e A

.1.6

b: P

rodu

ctiv

ity lo

ss (P

L) d

ue to

per

10

µg /m

3 ch

ange

in a

ir po

lluta

nt(s

) lev

el in

Zha

oqin

g

PL

(RM

B) p

er y

ear

du

e to

air

po

lluti

on

PL

(RM

B) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

- Pu

blic

C

ardi

ovas

cula

r dis

ease

s66

38,

888

127,

526

45,1

60

295,

882

13,1

97

407,

780

Re

spira

tory

dis

ease

s40

410

,991

129,

942

25,1

89

156,

997

22,8

05

294,

952

Co

st fo

r it

em (a

):25

7,46

8 70

,349

45

2,87

9 36

,002

70

2,73

1

(b) H

osp

ital

inp

atie

nts

- Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s66

329

74,

264

1,51

0 9,

893

441

13,6

35

Re

spira

tory

dis

ease

s40

436

74,

345

842

5,24

9 76

3 9,

862

Co

st fo

r it

em (b

):8,

609

2,35

2 15

,143

1,

204

23,4

97

(c) P

rem

atu

re d

eath

Fe

mal

e14

,753

4,03

1,29

51,

929,

509

18,1

58,0

54—

20,0

75,1

59

M

ale

14,7

538,

044,

510

3,85

0,36

436

,234

,671

—40

,060

,282

Co

st fo

r it

em (c

):12

,075

,804

5,77

9,87

254

,392

,725

—60

,135

,441

Tota

l pro

du

ctiv

ity

loss

(in

dir

ect h

ealt

h c

are

cost

):

12,3

41,8

815,

852,

573

54,8

60,7

4637

,206

60,8

61,6

69

Tota

l dir

ect a

nd

ind

irec

t hea

lth

car

e co

st:

39

,748

,346

11,

384,

217

6

6,83

2,22

9

2,34

9,55

6 10

2,90

4,50

3

73Appendices

Tabl

e A

.1.7

a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) i

n H

uizh

ou

Hea

lth

car

e co

st (R

MB

) per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (R

MB

) per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

—Pu

blic

C

ardi

ovas

cula

r dis

ease

s9,

858

10,5

683,

202,

538

12,6

75

375,

043

354,

207

3,87

6,97

8

Re

spira

tory

dis

ease

s6,

011

13,0

683,

263,

214

7,07

0 19

9,00

0 61

2,05

7 4,

045,

330

Co

st fo

r it

em (a

):6,

465,

752

19,7

45

574,

043

966,

265

7,92

2,30

8

(b) H

osp

ital

inp

atie

nts

—Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s9,

858

353

107,

081

424

12,5

40

11,8

43

129,

632

Re

spira

tory

dis

ease

s6,

011

437

109,

110

236

6,65

4 20

,465

13

5,26

1

Co

st fo

r it

em (b

):21

6,19

1 66

0 19

,194

32

,308

26

4,89

3

(c) H

osp

ital

ou

tpat

ien

ts a

nd

A

&E

visi

ts—

Pub

lic

C

ardi

ovas

cula

r dis

ease

s12

253

3,60

7 1

7,75

6,12

7

37,

139

147,

689

1,

384,

584

1

9,27

9,99

7

Re

spira

tory

dis

ease

s12

265

9,85

5 2

1,95

7,10

4

45,

926

182,

631

1,

712,

167

2

3,84

1,51

1

Co

st fo

r it

em (c

): 3

9,71

3,23

1

83,

066

330,

320

3,

096,

752

4

3,12

1,50

8

(d) H

osp

ital

ou

tpat

ien

ts—

Priv

ate

Re

spira

tory

dis

ease

s12

220

,971

697

,825

1,

460

5,

804

54,

415

75

7,71

4

Co

st fo

r it

em (d

):

6

97,8

25

1,46

0

5,8

04

54,

415

75

7,71

4

Tota

l dir

ect h

ealt

h c

are

cost

: 4

7,09

2,99

9

104,

930

929,

362

4,

149,

740

5

2,06

6,42

4

74Appendices

Tabl

e A

.1.7

b: P

rodu

ctiv

ity lo

ss (P

L) d

ue to

per

10

µg /m

3 ch

ange

in a

ir po

lluta

nt(s

) lev

el in

Hui

zhou

PL

(RM

B) p

er y

ear

du

e to

air

po

lluti

on

PL

(RM

B) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

- Pu

blic

C

ardi

ovas

cula

r dis

ease

s63

77,

465

146,

162

578

17,1

17

16,1

66

176,

943

Re

spira

tory

dis

ease

s38

89,

231

148,

931

323

9,08

2 27

,934

18

4,62

6

Co

st fo

r it

em (a

):29

5,09

3 90

1 26

,199

44

,100

36

1,56

9

(b) H

osp

ital

inp

atie

nts

- Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s63

725

04,

887

19

572

541

5,91

6

Re

spira

tory

dis

ease

s38

830

94,

980

11

304

934

6,17

3

Co

st fo

r it

em (b

):9,

867

30

876

1,47

5 12

,090

(c) P

rem

atu

re d

eath

Fe

mal

e14

,176

4,42

8,15

423

,688

1,00

6,73

5—

5,28

3,52

3

M

ale

14,1

769,

607,

262

51,3

932,

184,

199

—11

,463

,061

Co

st fo

r it

em (c

):14

,035

,416

75,0

813,

190,

934

—16

,746

,584

Tota

l pro

du

ctiv

ity

loss

(in

dir

ect h

ealt

h c

are

cost

):

14,3

40,3

7676

,012

3,21

8,00

945

,574

17,1

20,2

42

Tota

l dir

ect a

nd

ind

irec

t hea

lth

car

e co

st:

61,

433,

375

18

0,94

2

4,

147,

371

4,

195,

314

69,

186,

666

75Appendices

Tabl

e A

.1.8

a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) i

n D

ongg

uan

Hea

lth

car

e co

st (R

MB

) per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (R

MB

) per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

—Pu

blic

C

ardi

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cula

r dis

ease

s8,

622

5,83

81,

379,

601

600,

508

2,91

1,39

9 17

7,43

8 4,

248,

823

Re

spira

tory

dis

ease

s5,

257

7,21

91,

405,

739

334,

944

1,54

4,80

8 30

6,60

6 3,

147,

311

Co

st fo

r it

em (a

):2,

785,

340

935,

452

4,45

6,20

8 48

4,04

3 7,

396,

134

(b) H

osp

ital

inp

atie

nts

—Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s8,

622

195

46,1

29

20,0

79

97,3

46

5,93

3 14

2,06

5

Re

spira

tory

dis

ease

s5,

257

241

47,0

03

11,1

99

51,6

53

10,2

52

105,

235

Co

st fo

r it

em (b

):93

,132

31

,278

14

8,99

9 16

,185

24

7,30

0

(c) H

osp

ital

ou

tpat

ien

ts a

nd

A

&E

visi

ts—

Pub

lic

C

ardi

ovas

cula

r dis

ease

s67

294,

751

5

,006

,855

1,1

51,7

58

75

0,45

8

45

4,01

0

6,

563,

470

Re

spira

tory

dis

ease

s67

364,

487

6

,191

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1,4

24,2

56

92

8,01

1

56

1,42

5

8,

116,

342

Co

st fo

r it

em (c

): 1

1,19

8,29

7

2,5

76,0

15

1,67

8,46

9

1,01

5,43

5

14,

679,

812

(d) H

osp

ital

ou

tpat

ien

ts—

Priv

ate

Re

spira

tory

dis

ease

s67

11,5

84

1

96,7

72

4

5,26

5

29,

493

17,

843

25

7,94

8

Co

st fo

r it

em (d

):

1

96,7

72

4

5,26

5

29,

493

17,

843

25

7,94

8

Tota

l dir

ect h

ealt

h c

are

cost

: 1

4,27

3,54

1

3,5

88,0

10

6,31

3,16

9

1,53

3,50

6

22,

581,

193

76Appendices

Tabl

e A

.1.8

b: P

rodu

ctiv

ity lo

ss (P

L) d

ue to

per

10

µg /m

3 ch

ange

in a

ir po

lluta

nt(s

) lev

el in

Don

ggua

n

PL

(RM

B) p

er y

ear

du

e to

air

po

lluti

on

PL

(RM

B) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

- Pu

blic

C

ardi

ovas

cula

r dis

ease

s1,

133

4,09

812

7,22

4 55

,378

26

8,48

3 16

,363

39

1,81

7

Re

spira

tory

dis

ease

s69

15,

068

129,

634

30,8

88

142,

459

28,2

75

290,

238

Co

st fo

r it

em (a

):25

6,85

8 86

,265

41

0,94

2 44

,637

68

2,05

5

(b) H

osp

ital

inp

atie

nts

- Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s1,

133

137

4,25

4 1,

852

8,97

7 54

7 13

,101

Re

spira

tory

dis

ease

s69

116

94,

334

1,03

3 4,

763

945

9,70

4

Co

st fo

r it

em (b

):8,

588

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,740

1,

493

22,8

05

(c) P

rem

atu

re d

eath

Fe

mal

e25

,207

3,95

1,28

12,

324,

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16,1

87,9

47—

18,5

02,2

48

M

ale

25,2

078,

167,

342

4,80

5,00

233

,460

,669

—38

,244

,355

Co

st fo

r it

em (c

):12

,118

,623

7,12

9,61

649

,648

,616

—56

,746

,603

Tota

l pro

du

ctiv

ity

loss

(in

dir

ect h

ealt

h c

are

cost

):

12,3

84,0

707,

218,

766

50,0

73,2

9846

,130

57,4

51,4

64

Tota

l dir

ect a

nd

ind

irec

t hea

lth

car

e co

st:

26,

657,

611

1

0,80

6,77

6

56,

386,

467

1,

579,

636

80,

032,

657

77Appendices

Tabl

e A

.1.9

a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) i

n Zh

ongs

han

Hea

lth

car

e co

st (R

MB

) per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (R

MB

) per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

—Pu

blic

C

ardi

ovas

cula

r dis

ease

s7,

589

21,9

751,

316,

417

1,68

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084,

638

340,

223

8,29

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0

Re

spira

tory

dis

ease

s4,

628

27,1

741,

341,

358

939,

370

3,75

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7 58

7,89

2 5,

472,

084

Co

st fo

r it

em (a

):2,

657,

776

2,62

3,52

8 10

,843

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92

8,11

5 13

,770

,324

(b) H

osp

ital

inp

atie

nts

—Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s7,

589

168

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67

12,8

79

54,1

76

2,60

2 63

,456

Re

spira

tory

dis

ease

s4,

628

208

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57

7,18

3 28

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496

41,8

45

Co

st fo

r it

em (b

):20

,324

20

,062

82

,922

7,

097

105,

301

(c) H

osp

ital

ou

tpat

ien

ts a

nd

A

&E

visi

ts—

Pub

lic

C

ardi

ovas

cula

r dis

ease

s67

1,30

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8

6,1

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05

4

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75

1,

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1

0,94

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0

Re

spira

tory

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ease

s67

1,61

1,53

8

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67

5

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1

3,53

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5

Co

st fo

r it

em (c

):

9,2

95,6

12

5

,255

,266

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9

24,

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1

4,67

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2

(d) H

osp

ital

ou

tpat

ien

ts—

Priv

ate

Re

spira

tory

dis

ease

s67

9,97

3

4

7,04

2

31,

805

17

,981

8,57

2

83,

758

Co

st fo

r it

em (d

):

4

7,04

2

31,

805

17

,981

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2

83,

758

Tota

l dir

ect h

ealt

h c

are

cost

: 1

6,47

3,71

3

11,9

71,0

07

16,

199,

963

3,

448,

942

3

8,43

8,73

8

78Appendices

Tabl

e A

.1.9

b: P

rodu

ctiv

ity lo

ss (P

L) d

ue to

per

10

µg /m

3 ch

ange

in a

ir po

lluta

nt(s

) lev

el in

Zho

ngsh

an

PL

(RM

B) p

er y

ear

du

e to

air

po

lluti

on

PL

(RM

B) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

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(a) H

osp

ital

inp

atie

nts

- Pu

blic

C

ardi

ovas

cula

r dis

ease

s1,

002

17,6

2013

9,36

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8,30

2 75

0,05

3 36

,019

87

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7

Re

spira

tory

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ease

s86

821

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010

99,4

51

397,

983

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40

579,

331

Co

st fo

r it

em (a

):28

1,37

9 27

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148,

036

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60

1,45

7,86

8

(b) H

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ital

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atie

nts

- Pr

ivat

e

C

ardi

ovas

cula

r dis

ease

s1,

002

135

1,06

6 1,

363

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5 6,

718

Re

spira

tory

dis

ease

s86

816

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086

760

3,04

3 47

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430

Co

st fo

r it

em (b

):2,

152

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779

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48

(c) P

rem

atu

re d

eath

Fe

mal

e22

,302

990,

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,383

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M

ale

22,3

022,

045,

395

3,53

6,82

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—21

,446

,390

Co

st fo

r it

em (c

):3,

035,

729

5,24

9,28

131

,717

,044

—31

,830

,251

Tota

l pro

du

ctiv

ity

loss

(in

dir

ect h

ealt

h c

are

cost

):

3,31

9,26

05,

529,

159

32,8

73,8

5899

,011

33,2

99,2

68

Tota

l dir

ect a

nd

ind

irec

t hea

lth

car

e co

st:

19,

792,

973

1

7,50

0,16

6

49,

073,

822

3,

547,

953

71,

738,

005

79Appendices

Tabl

e A

.1.1

0a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) i

n M

SAR

Hea

lth

car

e co

st (H

K$)

per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (H

K$)

per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

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O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

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(a) H

osp

ital

inp

atie

nts

—Pu

blic

C

ardi

ovas

cula

r dis

ease

s

Fem

ale

and

Mal

e15

,339

572

172,

227

68,9

3197

,164

7,70

328

9,81

0

Re

spira

tory

dis

ease

s

Fem

ale

and

Mal

e23

,983

839

533,

768

116,

942

156,

811

40,4

8675

3,92

2

Co

st fo

r it

em (a

):70

5,99

518

5,87

325

3,97

548

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1,04

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2

(b) H

osp

ital

inp

atie

nts

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ivat

e

C

ardi

ovas

cula

r dis

ease

s15

,339

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415

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spira

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ease

s23

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2

Co

st fo

r it

em (b

):1,

312,

569

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546

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103

88,5

661,

949,

395

80Appendices

Tabl

e A

.1.1

0a: (

cont

inue

d)

Hea

lth

car

e co

st (H

K$)

per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (H

K$)

per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

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All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(c) P

ub

lic h

osp

ital

an

d o

ther

o

utp

atie

nt v

isit

s

S. J

anua

rio H

osp

ital

Car

diov

ascu

lar

dise

ases

1,23

8,60

6

Resp

irato

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isea

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1,08

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4

Car

diov

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lar

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Dis

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9

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3

Ca

rdio

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spira

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64,

623

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lic h

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es a

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r est

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hmen

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s36

614

8

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spira

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s36

635

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s53

18,

515

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st fo

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16,

187

Priv

ate

clin

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cen

tres

for a

uxili

ary

diag

nost

ic e

xam

inat

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and

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er

esta

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ts

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spira

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ease

s15

21,

069

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st fo

r it

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59,0

94

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90

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2

Tota

l dir

ect h

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are

cost

: 5

,329

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1

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67,7

27

241

,149

6

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81Appendices

A.1

.10b

: Pro

duct

ivity

loss

(PL)

due

to p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) l

evel

in M

SAR

PL

(HK

$) p

er y

ear

du

e to

air

po

lluti

on

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(HK

$) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

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All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

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osp

ital

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atie

nts

- Pu

blic

C

ardi

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ease

s1,

279

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368

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ease

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69

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st fo

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st fo

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035,

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Tota

l pro

du

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loss

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dir

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cost

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4,45

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6—

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2

Tota

l dir

ect a

nd

ind

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t hea

lth

car

e co

st:

9

,842

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3,

663,

146

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8

2

45,0

98

16,

434,

718

82Appendices

Tabl

e A

.1.1

1a: E

stim

ates

of u

nit c

ost,

freq

uenc

y of

hea

lth se

rvic

e ut

ilisa

tion

and

tota

l dire

ct h

ealth

car

e co

st p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) i

n H

ong

Kong

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lth

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e co

st (H

K$)

per

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r d

ue

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ir p

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n

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st (H

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itTo

tal n

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4 p

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sted

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2 2,

246,

059

550,

395

68,5

51

3,77

9,15

0

Resp

irato

ry d

isea

ses

2,91

1 (p

er b

ed-d

ay)

59,8

28(b

ed-d

ays)

3,03

6,32

4 1,

604,

000

373,

918

151,

663

4,15

9,71

8

Co

st fo

r it

em (b

):5,

363,

706

3,85

0,05

9 92

4,31

3 22

0,21

4 7,

938,

868

83Appendices

Hea

lth

car

e co

st (H

K$)

per

yea

r d

ue

to a

ir p

ollu

tio

n

Co

st (H

K$)

per

ep

iso

de/

vis

itTo

tal n

o. o

f ep

iso

des

/ vis

its

per

yea

r

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(c) A

ccid

ent a

nd

Em

erg

ency

Vis

it

Car

diov

ascu

lar d

isea

ses

531

276,

593

16,7

85,6

11

8,56

0,94

7 28

1,94

0 34

8,57

3 20

,881

,001

Resp

irato

ry d

isea

ses

531

297,

991

18,0

84,1

63

9,22

3,23

0 30

3,75

2 37

5,53

9 22

,496

,378

Co

st fo

r it

em (c

):34

,869

,774

17

,784

,177

58

5,69

2 72

4,11

1 43

,377

,379

(d) S

pec

ial O

utp

atie

nt C

linic

Vis

it

Car

diov

ascu

lar d

isea

ses

i.

Med

icin

e61

322

2,80

515

,628

,869

7,

970,

989

262,

511

324,

552

19,4

42,0

36

ii.

Sur

gery

613

101,

035

7,08

7,22

4 3,

614,

605

119,

041

147,

174

8,81

6,38

1

Resp

irato

ry d

isea

ses

i.

Med

icin

e61

324

0,04

116

,837

,935

8,

587,

633

282,

819

349,

659

20,9

46,0

92

ii.

Sur

gery

613

108,

851

7,63

5,49

9 3,

894,

234

128,

250

158,

560

9,49

8,42

6

Co

st fo

r it

em (d

)47

,189

,528

24

,067

,461

79

2,62

1 97

9,94

5 58

,702

,934

(e) G

ener

al O

utp

atie

nt C

linic

Vis

it

Car

diov

ascu

lar d

isea

ses

i.

Dep

artm

ent o

f Hea

lth

204

92,6

642,

156,

359

1,09

9,78

0 36

,219

44

,779

2,

682,

472

ii.

Hos

pita

l Aut

horit

y28

171

2,63

222

,873

,434

11

,665

,840

38

4,19

5 47

4,99

3 28

,454

,146

Resp

irato

ry d

isea

ses

i.

Dep

artm

ent o

f Hea

lth

204

99,8

112,

323,

177

1,18

4,86

0 39

,021

48

,243

2,

889,

991

ii.

Hos

pita

l Aut

horit

y28

176

7,76

224

,642

,947

12

,568

,322

41

3,91

6 51

1,73

9 30

,655

,389

Co

st fo

r it

em (e

):51

,995

,917

26

,518

,801

87

3,35

2 1,

079,

756

64,6

81,9

97

(f) P

riva

te G

ener

al P

ract

itio

ner V

isit

Resp

irato

ry d

isea

ses

152

25,5

61,4

3144

4,08

2,96

5 22

6,48

9,85

4 7,

459,

061

9,22

1,90

0 55

2,43

1,31

6

Co

st fo

r it

em (f

):44

4,08

2,96

5 22

6,48

9,85

4 7,

459,

061

9,22

1,90

0 55

2,43

1,31

6

To

tal d

irec

t hea

lth

car

e co

st:

658,

933,

852

352,

862,

904

23,6

36,0

11

15,3

22,5

32

838,

784,

424

Tabl

e A

.1.1

1a: (

cont

inue

d)

84Appendices

A.1

.11b

: Pro

duct

ivity

loss

(PL)

due

to p

er 1

0 µg

/m3

chan

ge in

air

pollu

tant

(s) l

evel

in H

ong

Kong

PL

(HK

$) p

er y

ear

du

e to

air

po

lluti

on

PL

(HK

$) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(a) H

osp

ital

inp

atie

nts

—Pu

blic

Car

diov

ascu

lar d

isea

ses

i.

Acu

te G

ener

al

Fem

ale

1,82

49,

351

220,

005

212,

317

52,0

286,

480

357,

238

Mal

e2,

195

13,1

3937

2,08

735

9,08

687

,994

10,9

6060

4,18

7

i.

Chr

onic

Infir

mar

y

Fem

ale

9,37

446

856

,635

54,6

5613

,393

1,66

891

,962

Mal

e9,

074

754

88,2

5985

,175

20,8

722,

600

143,

313

Resp

irato

ry d

isea

ses

ii.

Acu

te G

ener

al

Fem

ale

2,44

46,

471

275,

734

145,

662

33,9

5613

,773

377,

752

Mal

e2,

144

10,8

0640

3,95

821

3,39

949

,747

20,1

7855

3,41

7

ii.

Chr

onic

Infir

mar

y

Fem

ale

7,89

222

631

,104

16,4

313,

830

1,55

442

,612

Mal

e5,

408

793

74,7

5239

,489

9,20

63,

734

102,

409

Co

st fo

r it

em (a

):1,

522,

534

1,12

6,21

627

1,02

660

,945

2,27

2,89

0

85Appendices

A.1

.11b

: (c

ontin

ued)

PL

(HK

$) p

er y

ear

du

e to

air

po

lluti

on

PL

(HK

$) p

er

epis

od

e p

er y

ear

Tota

l no.

of

emp

loye

d

epis

od

es/

per

son

s-ye

ars

of

life

loss

per

yea

PM

10N

O2

SO2

O3

All

4 p

ollu

tan

ts

by

adju

sted

su

mm

atio

n (T

1)

AB

C =

A *

B *

ER

(b) H

osp

ital

inp

atie

nts

—Pr

ivat

e

Car

diov

ascu

lar d

isea

ses

500

(per

day

)9,

960

64,2

2461

,980

15,1

881,

892

104,

286

Resp

irato

ry d

isea

ses

500

(per

day

)6,

946

60,5

2431

,973

7,45

33,

023

82,9

17

Co

st fo

r it

em (b

):12

4,74

893

,953

22,6

424,

915

187,

203

(c) P

rem

atu

re D

eath

Fe

mal

e15

3,01

9 (p

er y

ear)

21,0

8927

,005

,092

35,2

24,6

5712

,398

,190

—51

,861

,681

M

ale

206,

494

(per

yea

r)61

,304

105,

935,

769

138,

179,

536

48,6

35,7

08—

203,

443,

374

Co

st fo

r it

em (c

):13

2,94

0,86

117

3,40

4,19

361

,033

,898

—25

5,30

5,05

5

Tota

l pro

du

ctiv

ity

loss

:13

4,58

8,14

417

4,62

4,36

261

,327

,567

65,8

6025

7,76

5,14

8

Tota

l dir

ect a

nd

ind

irec

t co

st:

793,

521,

996

527,

487,

267

84,9

63,5

7715

,388

,392

1,09

6,54

9,57

2

86Appendices

Tabl

e A

.2.1

: Cos

t sum

mar

y of

dire

ct a

nd in

dire

ct h

ealth

car

e co

st fo

r who

le p

opul

atio

n in

PRD

and

HK

(incl

udin

g m

alig

nant

neo

plas

ms)

PR

D (R

MB

)H

K$

GZ

SZZ

HFS

JMZQ

HZ

DG

ZS

Wh

ole

PR

DO

vera

ll 9

pre

fect

ure

sH

K

1. D

irec

t hea

lth

car

e co

st p

er y

ear

du

e to

air

po

lluti

on

PM

1074

,410

,645

3,32

5,72

31,

867,

269

51,9

04,9

928,

960,

231

7,81

3,54

212

,241

,929

4,45

6,81

04,

577,

157

169,

558,

299

18,8

39,8

1116

7,19

4,34

1

N

O2

21,9

19,2

232,

562,

190

1,86

1,29

432

,109

,275

1,00

0,03

72,

117,

589

36,8

871,

491,

630

4,48

2,09

867

,580

,222

7,50

8,91

410

7,62

0,27

8

SO

212

0,34

7,49

21,

437,

064

7,41

6,48

610

1,97

3,64

77,

186,

781

13,1

86,6

491,

038,

407

6,86

7,26

217

,926

,075

277,

379,

863

30,8

19,9

8525

,288

,523

O

38,

093,

355

590,

751

654,

871

1,99

4,38

982

7,93

41,

111,

414

1,86

7,85

378

5,26

81,

625,

430

17,5

51,2

651,

950,

141

7,44

1,96

6

Tota

l 4

pol

luta

nts*

192,

582,

775

6,17

4,10

69,

515,

119

152,

722,

047

16,2

35,0

7620

,869

,953

14,9

97,1

6811

,622

,146

23,0

98,1

5044

7,81

6,54

049

,757

,393

240,

002,

981

2. In

dir

ect h

ealt

h c

are

cost

per

yea

r d

ue

to a

ir p

ollu

tio

n

PM

1071

,792

,017

14,5

78,1

991,

696,

407

31,4

07,6

7810

,596

,884

12,3

44,7

0114

,343

,608

12,3

86,8

833,

322,

265

172,

468,

644

19,1

63,1

8313

4,60

8,73

5

N

O2

37,0

49,4

3112

,331

,598

2,86

1,31

333

,444

,621

2,06

4,11

75,

855,

571

76,0

507,

222,

441

5,54

0,69

910

6,44

5,84

111

,827

,316

174,

663,

286

SO

230

4,15

4,67

410

3,69

217

,075

,247

157,

947,

326

22,3

30,8

0354

,860

,746

3,21

8,00

950

,073

,298

32,8

73,8

5864

2,63

7,65

471

,404

,184

61,3

27,5

67

O

331

2,26

937

,007

,455

34,9

6483

,493

20,6

7037

,206

45,5

7446

,130

99,0

1137

,686

,773

4,18

7,41

965

,860

Tota

l 4

pol

luta

nts*

342,

784,

479

26,9

94,6

5317

,247

,717

177,

879,

220

30,2

21,7

1760

,865

,718

17,1

23,4

9057

,455

,785

33,3

07,0

0476

3,87

9,78

384

,875

,531

257,

801,

698

3. T

ota

l hea

lth

car

e co

st p

er y

ear

du

e to

air

po

lluti

on

PM

1014

6,20

2,66

217

,903

,923

3,56

3,67

783

,312

,670

19,5

57,1

1520

,158

,244

26,5

85,5

3716

,843

,693

7,89

9,42

234

2,02

6,94

338

,002

,994

301,

803,

076

N

O2

58,9

68,6

5314

,893

,788

4,72

2,60

665

,553

,895

3,06

4,15

57,

973,

159

112,

937

8,71

4,07

110

,022

,797

174,

026,

063

19,3

36,2

2928

2,28

3,56

4

SO

242

4,50

2,16

61,

540,

756

24,4

91,7

3325

9,92

0,97

329

,517

,584

68,0

47,3

954,

256,

415

56,9

40,5

6150

,799

,933

920,

017,

517

102,

224,

169

86,6

16,0

89

O

38,

405,

624

37,5

98,2

0668

9,83

52,

077,

883

848,

604

1,14

8,62

01,

913,

427

831,

398

1,72

4,44

255

,238

,038

6,13

7,56

07,

507,

826

Tota

l 4

pol

luta

nts*

535,

367,

253

33,1

68,7

5926

,762

,836

330,

601,

267

46,4

56,7

9381

,735

,671

32,1

20,6

5869

,077

,931

56,4

05,1

541,

211,

696,

323

134,

632,

925

497,

804,

679

* A

ll 4

pol

luta

nts

by a

djus

ted

sum

mat

ion

(T1)

Ap

pen

dix

2: C

ost s

umm

ary

tab

le o

n h

ealt

h c

are

cost

s d

ue to

air

pol

luti

on in

clud

ing

mal

ign

ant n

eop

lasm

s

87Appendices

Tabl

e A

.2.2

: Co

st su

mm

ary

of d

irect

and

indi

rect

hea

lth c

are

cost

per

one

mill

ion

popu

latio

n in

PRD

and

HK

(incl

udin

g m

alig

nant

neo

plas

ms)

PR

D (R

MB

)H

K$

GZ

SZZ

HFS

JMZQ

HZ

DG

ZS

Wh

ole

PR

DO

vera

ll 9

pre

fect

ure

sH

K

1. D

irec

t hea

lth

car

e co

st p

er y

ear

du

e to

air

po

lluti

on

PM

1011

,540

,368

2,01

3,94

72,

166,

824

14,7

92,3

912,

324,

134

1,98

2,87

74,

174,

955

2,75

1,64

43,

282,

410

45,0

29,5

515,

003,

283

24,6

47,2

09

N

O2

5,50

7,97

01,

551,

577

2,15

9,88

19,

150,

814

259,

393

537,

390

12,5

8092

0,93

53,

214,

241

23,3

14,7

812,

590,

531

15,8

65,0

07

SO

219

,378

,255

870,

238

8,60

6,22

329

,061

,445

1,86

4,13

13,

346,

435

354,

135

4,23

9,86

212

,855

,301

80,5

76,0

258,

952,

892

3,72

7,94

6

O

32,

400,

691

357,

739

759,

931

568,

381

214,

752

282,

048

637,

008

484,

826

1,16

5,64

36,

871,

018

763,

446

1,09

7,06

9

Tota

l 4

pol

luta

nts*

32,4

77,0

613,

738,

832

11,0

41,5

3343

,524

,220

4,21

1,10

75,

296,

261

5,11

4,59

57,

175,

537

16,5

64,3

4512

9,14

3,49

014

,349

,277

35,3

80,4

06

2. In

dir

ect h

ealt

h c

are

cost

per

yea

r d

ue

to a

ir p

ollu

tio

n

PM

1011

,134

,245

6,48

3,92

51,

968,

581

17,0

74,2

782,

748,

654

3,13

2,77

04,

890,

320

7,64

7,68

82,

382,

491

57,4

62,9

536,

384,

773

19,8

43,5

52

N

O2

9,30

9,96

38,

800,

809

3,32

0,38

618

,443

,375

535,

398

1,48

5,99

425

,933

4,45

9,15

13,

973,

394

50,3

54,4

025,

594,

934

25,7

48,2

55

SO

248

,974

,737

7,41

7,49

419

,814

,824

87,7

34,9

155,

792,

236

13,9

22,2

561,

097,

379

30,9

15,3

5923

,574

,785

239,

243,

986

26,5

82,6

659,

040,

697

O

392

,627

24,1

0840

,574

23,7

955,

361

9,44

215

,289

28,4

8171

,004

310,

681

34,5

209,

709

Tota

l 4

pol

luta

nts*

56,1

82,7

3516

,347

,061

20,0

14,9

6698

,357

,185

7,83

9,00

715

,446

,164

5,83

8,04

035

,473

,322

23,8

85,4

0627

9,38

3,88

631

,042

,654

38,0

04,2

31

3. T

ota

l hea

lth

car

e co

st p

er y

ear

du

e to

air

po

lluti

on

PM

1022

,674

,613

8,49

7,87

24,

135,

405

31,8

66,6

695,

072,

788

5,11

5,64

79,

065,

276

10,3

99,3

315,

664,

902

102,

492,

504

11,3

88,0

5644

,490

,761

N

O2

14,8

17,9

3410

,352

,386

5,48

0,26

627

,594

,189

794,

790

2,02

3,38

438

,513

5,38

0,08

67,

187,

635

73,6

69,1

838,

185,

465

41,6

13,2

62

SO

268

,352

,992

8,28

7,73

228

,421

,048

116,

796,

360

7,65

6,36

717

,268

,690

1,45

1,51

435

,155

,221

36,4

30,0

8631

9,82

0,01

135

,535

,557

12,7

68,6

43

O

32,

493,

317

381,

847

800,

505

592,

175

220,

114

291,

490

652,

297

513,

307

1,23

6,64

67,

181,

699

797,

967

1,10

6,77

8

Tota

l 4

pol

luta

nts*

88,6

59,7

9620

,085

,893

31,0

56,5

0014

1,88

1,40

512

,050

,114

20,7

42,4

2510

,952

,635

42,6

48,8

5940

,449

,750

408,

527,

377

45,3

91,9

3173

,384

,636

* A

ll 4

pol

luta

nts

by a

djus

ted

sum

mat

ion

(T1)

88Appendices

Appendix 3: Proxy geographic locations of 9 monitoring stations for sensitivity analysis based on satellite remote sensing information

Table A.3.1: Proxy geographic locations of 9 monitoring stations for sensitivity analysis based on satellite remote sensing information

Monitoring stations Address Sampling Height

Above Ground

Proxy Geographic Locations

lat lon

Wanqingsha (Guangzhou) Wanqingsha Secondary School, Nansha 13 m 12 m 22.80 113.50

Liyuan (Shenzhen) Shennan Zhong Road, Shenzhen City 38 m 12 m 22.59 114.10

Tangjia (Zhuhai) Building No. 1, Rong Yuan, Zhongshan University Tangjia

24 m 19 m 22.35 113.60

Huijingcheng (Foshan) No. 127, Fenjiang Nan Road, Changcheng Area

24 m 14 m 23.05 113.10

Donghu (Jiangmen) Inside Donghu Park, Jiangmen City 17.5 m 5 m 22.60 113.10

Chengzhong (Zhaoqing) No. 17, Qintian Road, Zhaoqing City 21 m 16 m 23.10 112.50

Xiapu (Huizhou) No. 4 Xiabuhengjiang Road No. 3. Huicheng Area

49 m 20 m 23.10 114.45

Haogang (Dongguan) Haogang Primary School, Nancheng Qu, Dongguan City

18 m 14 m 23.05 113.75

Zimaling Park (Zhongshan)

Zimaling Park, Zhongshan City 45 m 7 m 22.50 113.45

* Approximate locations are determined by map overlaying technique based on PRDRAQmn annual report (2006)

89Appendices

Zhongshan (Zimaling Park)

www.chinese-tourism.net/China_Travel/a4/9994.html

Zhuhai (Tangjia)

ucmi.bokee.com/4619053.html

Appendix 4: Surrounding appearance of the monitoring stations in Jiangmen, Shenzhen, Zhongshan, and Zhuhai.

Jiangmen (Donghu)

www.jiangmen.gov.cn/lyz/lyjd/llp/t20060508_48056.html

Shenzhen (Liyuen)

www.book-hotel.cn/date/art/178.html

90Appendices

Table A.5.1: Annual average air pollutant concentration (in µg/m3) in nine prefectures of Pearl River Delta (PRD), MSAR (M)and

Hong Kong (HK)

Pollutant Pearl River Delta (PRD)

GZ SZ ZH FS JM ZQ HZ DG ZS PRD** M** HK**

PM10

89 60 41 115 70 79 103 94 41 77 73 55

NO2

49 61 40 79 37 50 34 56* 50 50 43 57

SO2

73 27 51 108 37 67 21 74* 59 56 23 23

O3

45 39 48 38 37 47 54 54* 45 44 34 32

Note: * indicated no data available from January to August. Missing data from these 8 months in DG was estimated by using the ratio

of the annual average of an air pollutant level in DG to the annual average of the same air pollutant level in PRD.

**PRD represents average levels of the 9 monitoring stations; M represents average levels of the 2 monitoring stations; HK represents

average levels of the 10 monitoring stations

GZ: Guangzhou

SZ: Shenzhen

ZH: Zhuhai

FS: Foshan

JM: Jiangmen

ZQ: Zhaoqing

HZ: Huizhou

DG: Dongguan

ZS: Zhongshan

PRD: Pearl River Delta

M: MSAR

HK: Hong Kong

Appendix 5: Annual average concentration (in µg/m3) of each pollutant in nine prefectures of Pearl River Delta, MSAR and Hong Kong

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