Air Pollution, Socioeconomic Status, and Hospital Emergency Visits: An Empirical Analysis in Victoria, Australia
Creators: name: Shafiei, Sahar
Publisher: name: RMIT University
Year: 2025
Subjects: classificationCode: 380108
subject: Health economics

description: Air pollution has increasingly become a pressing global issue due to its wide-ranging adverse effects on human health, including elevated rates of emergency department presentations, hospital admissions, and premature mortality. While air quality in Australia is generally considered good by international standards, the health impacts of air pollution, even at relatively low levels, remain significant. This thesis examines the relationship between air pollution and healthcare utilisation in Victoria, Australia, focusing on the effects of specific pollutants, including particulate matter (PM10 and PM2.5), carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and sulphur dioxide (SO2), on hospital emergency visits for respiratory and cardiovascular diseases. The study spans the period 2013 to 2016, exploring how pollution impacts different populations, particularly vulnerable groups, and assessing the role of socioeconomic factors in shaping these effects.
The first empirical chapter investigates pollution exposure and healthcare utilisation in a highly polluted area of Victoria—the Latrobe Valley—characterised by homogenous populations and coal-fired power station emissions. Using negative binomial regression, the analysis establishes a significant association between air pollutant concentrations and hospital emergency visits. Vulnerable populations, including children and seniors, are identified as experiencing the most severe health effects. Seasonal variations and weather conditions, such as temperature and humidity, further influence the relationship between pollution and health outcomes. These findings underscore the acute health risks posed by localised pollution events, such as those resulting from coal combustion, and highlight the need for targeted health interventions in high-exposure regions.
The second chapter adopts a broader perspective by analysing state-wide data while addressing endogeneity concerns associated with pollution exposure. Employing an instrumental variable (IV) technique, with wind speed as an instrument, this chapter estimates the causal effect of particulate matter on hospital emergency visits. The findings reveal that PM10 and PM2.5 are significantly associated with increased respiratory-related emergency visits, particularly among children under five years old, a highly vulnerable demographic. The study’s results underscore the disproportionate health burden of air pollution on young children and demonstrate the importance of incorporating causal estimation methods in air pollution research. These findings provide evidence supporting stricter air quality regulations and public health strategies aimed at reducing childhood exposure to particulate matter.
The final empirical chapter examines the interaction between socioeconomic status (SES) and air pollution in shaping health outcomes. By merging community-level demographic data with hospital emergency visit records, the analysis highlights the compounding effects of environmental and social inequities. Low-SES communities are shown to experience significantly higher rates of pollution-related hospital emergency visits compared to high-SES communities, even after controlling for other factors. The results indicate that lower-income and less-educated populations are more vulnerable to the health impacts of air pollution due to their higher exposure to pollutants and reduced capacity for mitigation. Additionally, the chapter examines the role of disability as an additional vulnerability factor, finding that individuals with disabilities are particularly at risk of increased healthcare utilisation in polluted environments. These findings emphasize the need for integrated policies that address both environmental health risks and the social determinants of health.
This thesis demonstrates that air pollution in Victoria, even at relatively low levels, imposes a significant health burden, particularly on vulnerable populations such as children, low-SES communities, and individuals with disabilities. The findings emphasize the need for targeted interventions and policy reforms to mitigate these impacts. Key recommendations include:
1. Stricter Air Quality Standards: Establishing more stringent pollution limits to reduce particulate matter and gaseous pollutant levels, particularly in high-exposure regions such as the Latrobe Valley.
2. Targeted Support for Vulnerable Populations: Developing community-specific programs to reduce pollution exposure in low-SES areas, improve access to healthcare, and raise awareness about air quality and mitigation strategies.
3. Integrated Policy Approaches: Addressing the compounded effects of environmental and socioeconomic disparities through cross-sector collaboration between environmental regulators, healthcare providers, and social policy agencies.
4. Future Research: Conducting longitudinal studies to assess the long-term impacts of air pollution on health outcomes and exploring the cost-effectiveness of interventions aimed at reducing healthcare utilisation caused by pollution exposure.
This research contributes to the growing body of evidence on the intersection of air pollution, health, and social inequities, providing a robust foundation for policies aimed at improving public health and advancing environmental justice.