Air Pollution and Extended Hospital Burden: A Proxy Approach to Health and Economic Strain in the Greater Athens Area, Greece

This study investigates the health and economic burden of air pollution in the Greater Athens Area, Greece, from 2018 to 2022, by comparing daily hospital admissions and overall hospital stays for cardiovascular and respiratory diseases. Using data from six major hospitals and air quality records for NO2, O3, PM10, and PM2.5, we applied a Distributed Lag Non-Linear Model to estimate cumulative relative risks (RR). Results show that while both indicators increase with declining air quality, hospital stays consistently yield higher RRs, better capturing the prolonged strain on healthcare resources. Even Fair air quality was associated with an 8% increase in hospital burden (RR = 1.08, 95% CI: 1.06–1.12), while Extremely Poor conditions corresponded to a 24% increase (RR = 1.24, 95% CI: 1.07–1.43). Economic estimates based on length of stay and standardized hospitalization costs indicate a substantial financial impact. These findings underscore the importance of using hospital burden as a sensitive proxy for health and economic strain, reinforcing the need for stricter air quality management and targeted public health interventions.