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The U.S. healthcare system has increased its greenhouse gas emissions across the last decade, and remains the greatest polluter of any industrialized healthcare system in the world, according to a new study.

Greenhouse gas emissions from the U.S. healthcare system rose by 6% across the last decade, with emissions reaching 1,692 kg per capita in 2018, reported Jodi Sherman, MD, of the Yale School of Medicine in New Haven, Connecticut, and colleagues.

In 2018, greenhouse gas emissions and toxic air pollutants resulted in the loss of 388,000 disability-adjusted life-years, the group wrote in .

In a state-level analysis, the researchers found that quality health metrics were not associated with emissions, suggesting an opportunity to reduce environmental waste in healthcare without compromising quality care, the researchers said.

"We had an intuition that [emissions] were going to be significant, because the amount of money that we spend on healthcare is so enormous," said co-author Matthew Eckelman, PhD, of Northeastern University in Boston.

Eckelman said that increased emissions in the healthcare sector are largely driven by spending. Money spent on drugs, medical devices, hospital supplies, and other resources result in emissions from the production of those goods.

"In general, the more money we spend, the more emissions we are going to get," he said.

"Unsurprisingly, healthcare is a major contributor to greenhouse gas emissions and air pollution," said Aaron Bernstein, MD, MPH, interim director of the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health in Boston.

Bernstein, who was not involved in the study, told 麻豆传媒 that high greenhouse gas emissions from the U.S. healthcare system are a result of wasteful spending. The healthcare sector spends a ton of money to care for a population whose health is declining, he said. But as a result, it creates worse population health through its contributions to pollution, and the overall climate crisis.

"Healthcare in the U.S. is not only costing us dearly -- and we have a population health that's getting worse -- but it is contributing more than any other healthcare system in the world to harm," Bernstein said.

The U.S. healthcare system is responsible for around a quarter of worldwide greenhouse gas emissions, Sherman's group noted. In 2013, the damage stemming from this pollution was equivalent to that of deaths from preventable medical errors.

Sherman and colleagues updated their on national-level healthcare emissions, using models developed by the Environmental Protection Agency. They obtained data from the National Health Expenditure Accounts of the Centers for Medicare and Medicaid Services (CMS) from 2010 to 2018.

The researchers stratified emissions into three groups: direct from hospitals and other healthcare sectors (energy use and anesthetic gases), indirect from expenditures on electricity, and indirect from the production of healthcare goods and services.

Sherman's group also estimated state-level emissions, examining the association with energy use, as well as with health quality metrics, using CMS data from 2014. This study was the first to estimate state-level healthcare emissions.

Overall, healthcare emissions increased by 6% from 2010 to 2018, with a dip in emissions during 2012. Emissions from the healthcare system make up around 8.5% of total greenhouse gas emissions in the U.S.

More than 80% of national healthcare sector emissions were contributed by the supply chain, with pharmaceuticals and chemicals having the most impact on pollution. Expenditures on electricity contributed to about 11% of overall healthcare emissions, and direct emissions from hospitals and other facilities contributed about 7%.

Sherman and colleagues recognized that this research is limited by the aggregate nature and static economic structure of the model used for analysis.

The researchers suggested that policies such as mandatory reporting of emissions from healthcare facilities, as well as sustainability oversight by regulatory agencies, will incentivize the healthcare system to decrease unnecessary consumption and decarbonize energy generation. However, a focus on the supply chain for healthcare goods and services is key.

"A partnership approach to addressing these supply chain emissions is really necessary," Eckelman said. Solutions like green building design, hospital energy efficiency projects, and procurement of renewable electricity are significant -- but not enough, he said.

"All of that is really important, but it will not get us to zero in terms of healthcare emissions," Eckelman said. "The healthcare industry can only do so much by itself."

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