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Adding to the Woes: Heterogeneous Effects of Air Pollution on Pandemic Patients

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  • Mengdi Liu
  • Xin Zhao

Abstract

While the direct health impacts of air pollution are widely discussed, its indirect effects, particularly during pandemics, are less explored. Utilizing detailed individual‐level data from all designated hospitals in Wuhan during the initial COVID‐19 outbreak, we examine the impact of air pollution exposure on treatment costs and health outcomes for COVID‐19 patients. Our findings reveal that patients exposed more intensively to air pollution, identified by their residence in downwind areas of high‐polluting enterprises, not only had worsened health outcomes but also consumed more medical resources. This increased demand is primarily due to their heightened vulnerability to cardiopulmonary conditions. Using a causal machine learning method called Causal Forests to estimate individual treatment effects, we uncover significant heterogeneity across demographic and socioeconomic characteristics, with older and economically disadvantaged patients showing particular vulnerability. These findings highlight the importance of considering environmental factors in pandemic preparedness and suggest the value of targeted interventions that account for demographic and socioeconomic variations in vulnerability.

Suggested Citation

  • Mengdi Liu & Xin Zhao, 2025. "Adding to the Woes: Heterogeneous Effects of Air Pollution on Pandemic Patients," Health Economics, John Wiley & Sons, Ltd., vol. 34(4), pages 655-676, April.
    • Handle: RePEc:wly:hlthec:v:34:y:2025:i:4:p:655-676
    DOI: 10.1002/hec.4930
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    1. Tatyana Deryugina & Garth Heutel & Nolan H. Miller & David Molitor & Julian Reif, 2019. "The Mortality and Medical Costs of Air Pollution: Evidence from Changes in Wind Direction," American Economic Review, American Economic Association, vol. 109(12), pages 4178-4219, December.
    2. Adhvaryu, Achyuta & Molina, Teresa & Nyshadham, Anant & Tamayo, Jorge & Torres, Nicolas, 2023. "The health costs of dirty energy: Evidence from the capacity market in Colombia," Journal of Development Economics, Elsevier, vol. 164(C).
    3. Alpino, Matteo & Hauge, Karen Evelyn & Kotsadam, Andreas & Markussen, Simen, 2022. "Effects of dialogue meetings on sickness absence—Evidence from a large field experiment," Journal of Health Economics, Elsevier, vol. 83(C).
    4. Isphording, Ingo E. & Pestel, Nico, 2021. "Pandemic meets pollution: Poor air quality increases deaths by COVID-19," Journal of Environmental Economics and Management, Elsevier, vol. 108(C).
    5. Alex Hollingsworth & Ivan Rudik, 2021. "The Effect of Leaded Gasoline on Elderly Mortality: Evidence from Regulatory Exemptions," American Economic Journal: Economic Policy, American Economic Association, vol. 13(3), pages 345-373, August.
    6. Kenneth Y. Chay & Michael Greenstone, 2003. "The Impact of Air Pollution on Infant Mortality: Evidence from Geographic Variation in Pollution Shocks Induced by a Recession," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 118(3), pages 1121-1167.
    7. Stefan Wager & Susan Athey, 2018. "Estimation and Inference of Heterogeneous Treatment Effects using Random Forests," Journal of the American Statistical Association, Taylor & Francis Journals, vol. 113(523), pages 1228-1242, July.
    8. Braveman, P.A. & Kumanyika, S. & Fielding, J. & LaVeist, T. & Borrell, L.N. & Manderscheid, R. & Troutman, A., 2011. "Health disparities and health equity: The issue is justice," American Journal of Public Health, American Public Health Association, vol. 101(SUPPL. 1), pages 149-155.
    9. Christopher R. Knittel & Douglas L. Miller & Nicholas J. Sanders, 2016. "Caution, Drivers! Children Present: Traffic, Pollution, and Infant Health," The Review of Economics and Statistics, MIT Press, vol. 98(2), pages 350-366, May.
    10. Kenneth Y. Chay & Michael Greenstone, 2005. "Does Air Quality Matter? Evidence from the Housing Market," Journal of Political Economy, University of Chicago Press, vol. 113(2), pages 376-424, April.
    11. Janet Currie & Johannes F. Schmieder, 2009. "Fetal Exposures to Toxic Releases and Infant Health," American Economic Review, American Economic Association, vol. 99(2), pages 177-183, May.
    12. Tanaka, Shinsuke, 2015. "Environmental regulations on air pollution in China and their impact on infant mortality," Journal of Health Economics, Elsevier, vol. 42(C), pages 90-103.
    13. H. Spencer Banzhaf & Randall P. Walsh, 2008. "Do People Vote with Their Feet? An Empirical Test of Tiebout," American Economic Review, American Economic Association, vol. 98(3), pages 843-863, June.
    14. Currie, Janet & Neidell, Matthew & Schmieder, Johannes F., 2009. "Air pollution and infant health: Lessons from New Jersey," Journal of Health Economics, Elsevier, vol. 28(3), pages 688-703, May.
    15. Li, Qi & Racine, Jeffrey S, 2008. "Nonparametric Estimation of Conditional CDF and Quantile Functions With Mixed Categorical and Continuous Data," Journal of Business & Economic Statistics, American Statistical Association, vol. 26, pages 423-434.
    16. Ingo E. Isphording & Nico Pestel, 2021. "Pandemic Meets Pollution: Poor Air Quality Increases Deaths by COVID-19," CRC TR 224 Discussion Paper Series crctr224_2020_262, University of Bonn and University of Mannheim, Germany.
    17. Janet Currie & Matthew Neidell, 2005. "Air Pollution and Infant Health: What Can We Learn from California's Recent Experience?," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 120(3), pages 1003-1030.
    18. Jennifer A. Burney, 2020. "The downstream air pollution impacts of the transition from coal to natural gas in the United States," Nature Sustainability, Nature, vol. 3(2), pages 152-160, February.
    19. Cropper, Maureen L., 2000. "Has Economic Research Answered the Needs of Environmental Policy?," Journal of Environmental Economics and Management, Elsevier, vol. 39(3), pages 328-350, May.
    20. Michael Rendall & Margaret Weden & Melissa Favreault & Hilary Waldron, 2011. "The Protective Effect of Marriage for Survival: A Review and Update," Demography, Springer;Population Association of America (PAA), vol. 48(2), pages 481-506, May.
    21. Deschenes, Olivier & Wang, Huixia & Wang, Si & Zhang, Peng, 2020. "The effect of air pollution on body weight and obesity: Evidence from China," Journal of Development Economics, Elsevier, vol. 145(C).
    22. Panle Jia Barwick & Shanjun Li & Deyu Rao & Nahim Bin Zahur, 2018. "The Morbidity Cost of Air Pollution: Evidence from Consumer Spending in China," Working Papers id:12825, eSocialSciences.
    23. Janet Currie & Lucas Davis & Michael Greenstone & Reed Walker, 2015. "Environmental Health Risks and Housing Values: Evidence from 1,600 Toxic Plant Openings and Closings," American Economic Review, American Economic Association, vol. 105(2), pages 678-709, February.
    24. Jonathan M.V. Davis & Sara B. Heller, 2017. "Using Causal Forests to Predict Treatment Heterogeneity: An Application to Summer Jobs," American Economic Review, American Economic Association, vol. 107(5), pages 546-550, May.
    25. Lucas W. Davis, 2011. "The Effect of Power Plants on Local Housing Values and Rents," The Review of Economics and Statistics, MIT Press, vol. 93(4), pages 1391-1402, November.
    26. Braveman, P.A. & Cubbin, C. & Egerter, S. & Williams, D.R. & Pamuk, E., 2010. "Socioeconomic disparities in health in the united States: What the patterns tell us," American Journal of Public Health, American Public Health Association, vol. 100(S1), pages 186-196.
    27. Gupta, Aashish & Spears, Dean, 2017. "Health externalities of India's expansion of coal plants: Evidence from a national panel of 40,000 households," Journal of Environmental Economics and Management, Elsevier, vol. 86(C), pages 262-276.
    28. Glynn, Adam N. & Quinn, Kevin M., 2010. "An Introduction to the Augmented Inverse Propensity Weighted Estimator," Political Analysis, Cambridge University Press, vol. 18(1), pages 36-56, January.
    29. Imbens,Guido W. & Rubin,Donald B., 2015. "Causal Inference for Statistics, Social, and Biomedical Sciences," Cambridge Books, Cambridge University Press, number 9780521885881, December.
    30. Jha, Akshaya & Muller, Nicholas Z., 2018. "The local air pollution cost of coal storage and handling: Evidence from U.S. power plants," Journal of Environmental Economics and Management, Elsevier, vol. 92(C), pages 360-396.
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