Economic impact of cardiopulmonary morbidity due to ambient air temperature exposure in Norway

Background: The economic impact of Cardiopulmonary diseases (CPDs) in Europe have been proven to be substantial. This study aimed to estimate the economic burden of CPDs in Norway, and to assess the relationship between ambient air temperature and the direct health care costs from the Norway Control and Payment of Health Reimbursements (KUHR). Additionally, associations between sex, age, and socioeconomic factors and these costs were assessed. Problem statement: Economic impact of cardiopulmonary morbidity due to ambient air temperature exposure in Norway Method: This retrospective cost-of-illness study was based on the Cohort of Norway (CONOR) cohort in the years 2008-2018 and linked to healthcare costs retrieved from KUHR, and data on education and income variables from Statistics Norway. Data on daily mean ambient air temperature exposure was retrieved from the SeNorge2 dataset, with a grid spacing of 1km. Direct healthcare costs in 2018 Norwegian Kroner (NOK) were calculated by using reimbursement rates from KUHR, and a generalized linear model was applied to assess the costs related to ambient air temperature exposure, as well as sociodemographic factors. Results: A total of 139 567 participants with a mean age of 68.2, was included. The total cost of CPD in the period 2008-2018 was NOK 1 512 651 719, of which 66.3% related to cardiovascular disease (CVD) visits, 31.2% to respiratory disease (RD) visits, and 2.4% for visits relating to both. A 1℃ increase in mean temperature the preceding week to a visit was associated with a 0.33% increase in cost (p<0.001). RD related costs increased with 0.55% (p<0.001). No association was found between temperature exposure and cost impact for CVD visits or visits with both. Sex, age, and education levels were significantly associated with changes in health care costs. Females had 7.36% (p<0.001) lower costs than males in total. RD costs increased with 0.72% (p<0.001) per year of age, but CVD costs decreased by 0.21% per year (p<0.001). Each level of higher education was associated with a 2.42% (p<0.001) decrease in RD costs, but a 2.76% (p