Abstract: TH-OR050
Effects of Air Quality on Health Outcomes and Health Care Use in Patients with CKD
Session Information
- CKD Outcomes: Novel Biomarkers, Interventions, and Multiorgan Crosstalk
October 22, 2026 | Location: Mile High Ballroom 1D, Convention Center
Abstract Time: 05:10 PM - 05:20 PM
Category: CKD (Non-Dialysis)
- 2201 CKD (Non-Dialysis): Epidemiology, Risk Factors, and Prevention
Authors
- Van Der Goes, David N., University of New Mexico, Albuquerque, New Mexico, United States
- Sleeper, Colin, University of New Mexico, Albuquerque, New Mexico, United States
- Walkup, Alix, University of New Mexico, Albuquerque, New Mexico, United States
Background
Using EPA AQI data linked with MarketScan commercial insurance claims, this study examines whether short-term exposure to poor air quality increases healthcare utilization among commercially insured adults with CKD in the United States from 2016 to 2019. The analysis is motivated by concerns about worsening air quality associated with wildfire smoke and deregulation. While prior research links pollution exposure to adverse health outcomes, less is known about how short-term fluctuations in AQI affect healthcare demand at the individual level.
Methods
Daily AQI data from the EPA were merged with enrollee-day claims data for ~100,000 continuously enrolled adults aged 18–64 across ~300 MSAs. The study constructs a five-day moving average AQI measure and categorizes exposure into EPA-defined bins: "good" (<51), "moderate" (51–101), "unhealthy for sensitive groups" (101–151), and "unhealthy/hazardous" (151+). Outcomes include (1) the probability of any healthcare encounter on a given enrollee-day and (2) total healthcare spending per enrollee-day. Logistic regression, Poisson pseudo-maximum likelihood (PPML), ordinary least squares, and panel fixed-effects models were estimated with demographic, temporal, and geographic controls.
Results
Worsening air quality is associated with increased healthcare utilization. Relative to days with "good" air quality, "moderate" AQI days are associated with approximately 4–5% increases in the probability of a healthcare encounter, while the highest AQI category corresponds to roughly 7–8% increases across model specifications. LPM produced similar estimates. Evidence for increased healthcare spending is weaker but suggests modest increases in per-enrollee spending during moderate pollution periods. Subgroup analyses reveal heterogeneous responses, with larger effects among males and individuals with co-occurring mental health diagnoses.
Conclusion
Estimated effects imply substantial aggregate impacts when scaled to the US population and repeated exposure periods. Back-of-the-envelope calculations suggest that additional days in the "moderate" AQI category may generate thousands of additional healthcare encounters and millions of dollars in associated healthcare costs. The findings indicate that short-term deterioration in air quality produces measurable increases in healthcare demand and highlight environmental quality as an important determinant of healthcare system burden.