The impacts of long-term exposure to PM2.5 on cancer hospitalizations in Brazil.

BACKGROUND: Long-term exposure to PM2.5 has been linked to cancer incidence and mortality. However, it was unknown whether there was an association with cancer hospitalizations. METHODS: Data on cancer hospitalizations and annual PM2.5 concentrations were collected from 1,814 Brazilian cities during 2002-2015. A difference-in-difference approach with quasi-Poisson regression was applied to examine State-specific associations. The State-specific associations were pooled at a national level using random-effect meta-analyses. PM2.5 attributable burden were estimated for cancer hospitalization admissions, inpatient days and costs. RESULTS: We included 5,102,358 cancer hospitalizations (53.8% female). The mean annual concentration of PM2.5 was 7.0 µg/m3 (standard deviation: 4.0 µg/m3). With each 1 µg/m3 increase in two-year-average (current year and previous one year) concentrations of PM2.5, the relative risks (RR) of hospitalization were 1.04 (95% confidence interval [CI]: 1.02 to 1.07) for all-site cancers from 2002 to 2015 without sex and age differences. We estimated that 33.82% (95%CI: 14.97% to 47.84%) of total cancer hospitalizations could be attributed to PM2.5 exposure in Brazil during the study time. For every 100,000 population, 1,190 (95%CI: 527 to 1,836) cancer hospitalizations, 8,191 (95%CI: 3,627 to 11,587) inpatient days and US$788,775 (95%CI: $349,272 to $1,115,825) cost were attributable to PM2.5 exposure. CONCLUSIONS: Long-term exposure to ambient PM2.5 was positively associated with hospitalization for many cancer types in Brazil. Inpatient days and cost would be saved if the annual PM2.5 exposure was reduced.

Guatemala: the economic burden of illness and health system implications.

OBJECTIVES: To assess the economic burden of ill health in Guatemala, the characteristics of Guatemala's health system that potentially explain this burden, and to identify policies to help ameliorate it. METHODS: Data from the 2000 and 2006 Living Standard Measurement Surveys are used to assess levels of financial burden from ill health, along with information on health system characteristics of Guatemala and recent reform experiences of several middle- and low-income countries. RESULTS: Despite some gains over the period from 2000 to 2006, there continues to be both a high level and inequitable distribution of financial burden associated with ill health in Guatemala. Low levels of insurance coverage, a heavy concentration of the uninsured among the less well off and rural populations, as well as their low levels of access to public services are important drivers of out of pocket spending on health. Households with older members also appear to be at increased risk for out of pocket payments. CONCLUSIONS: High levels of catastrophic health spending and poverty co-exist with significant economic inequality and poverty in Guatemala. With health system features and a large informal sector similar to many other developing countries, recent international experience can provide useful lessons to help Guatemala devise innovative financing and payment mechanisms to address these concerns.