Children are bearing the burden due to increased respiratory testing, insurance claims due to smog across India. india news

As air quality worsens, cough, wheezing and breathing problems are leading to a rise in medical tests in Indian cities, especially among school-going children. Top laboratories in Delhi-NCR are reporting an increase in screening for asthma, allergies and lung function, while health insurers are reporting a rise in hospitalization claims linked to pollution-related illnesses.

Doctors and clinical chains say persistent coughing, wheezing, shortness of breath and allergy flare-ups are prompting both children and older adults to undergo pulmonary function tests, allergy profiles, IgE panels and cardiac evaluations. On the other hand, insurers are reporting a huge surge in respiratory claims.

Health insurance data underscores the scale of the problem. ManipalCigna Health Insurance says respiratory claims during winter have increased more than fourfold between 2020 and 2024, while Policybazaar reports that pollution-related illnesses now account for more than eight per cent of all hospitalization claims, with children being the largest affected group. Laboratory and insurance data combined point to air pollution evolving from a seasonal nuisance to a recurring burden on public health. This year, pollution-related claims before Diwali increased by 7.6 per cent, while pollution-related claims after Diwali (till September) increased by 9 per cent compared to previous years.

Children and the elderly are most vulnerable

Diagnostic laboratories told News18 that the impact of poor air quality is most visible on children and the elderly. According to Dr. Mayank Lodha Seth, chief pathologist at Radcliffe Labs, “Deteriorating air quality, especially during winter smog, is prompting two key age groups to undergo a series of diagnostic tests: children and the elderly”.

Children under 14 are increasingly being tested for asthma, bronchitis and seasonal respiratory infections, with pulmonary function tests, allergy profiles and complete blood counts. “Children, especially those under the age of 14, are extremely vulnerable because their lungs and immune systems are still developing,” Seth said. “They are undergoing pulmonary function test, allergy profile and complete blood count (CBC) due to increasing cases of asthma, bronchitis and seasonal respiratory infections.”

At the other end of the age range, adults over the age of 60 are also seeking evaluations more frequently. “Elders aged 60 and older are also increasingly seeking evaluations such as ECG,” she said, adding that chronic conditions such as COPD, heart disease, diabetes and weakened immunity increase their vulnerability during high pollution periods.” While this trend cuts across genders, patients with a history of smoking, occupational exposure or pre-existing respiratory disease are reporting more severe symptoms.

Seasonal lab data support this pattern. Hinal Shah, consultant biochemist at Agillus Diagnostics’ Global Reference Lab, told News18 that laboratories consistently see higher respiratory tests between October and December compared to July to September, which is due to “degradation in air quality (AQI), changes in temperature, lower dispersion of pollutants and higher allergen load”.

This increase includes children between five and 15 years of age and adults above 60 years of age. “Children (5-15 years) complain of frequent cough, wheezing, allergic rhinitis and asthma, while the elderly, especially those with pre-existing COPD, asthma or heart disease, need to undergo frequent or extended testing,” Shah said. While gender distribution is broadly comparable, they observed a slight predominance of males in the adult trial, likely due to greater outdoor and occupational exposure.

According to data shared by Tarun Bhamra, Orange Labs spokesperson, the increase is widespread across all age groups, but is most pronounced in young children. “The largest increase has been seen in primary school-aged children (6-11 years), where the amount of allergy testing increased 2.6-fold from July-September to October-December,” he said, attributing this to increased outdoor exposure.

Individuals with asthma, allergies or weakened immunity are also undergoing more frequent and extensive testing during periods of poor air quality.

Rapid growth is seen in urban and high-traffic areas

Geography is emerging as a key driver of testing volume. Big cities and industrial areas are seeing rapid increases as winter pollution traps pollutants closer to the ground. According to Radcliffe Labs’ Seth, Delhi-NCR, Gurugram, Noida, Ghaziabad and parts of Haryana and Punjab often record very poor AQI levels during winter, leading to increased exposure to PM2.5 and PM10 among school children, outdoor workers and older adults.

Similarly, Shah said the trend is “more pronounced in urban and peri-urban areas, especially in high-traffic areas, industrial belts and cities with known seasonal declines in AQI”. He said laboratories serving densely populated metros are seeing a much higher increase in testing volumes compared to semi-urban or rural areas, with construction activity, biomass exposure and stubble burning further worsening air quality.

City-level diagnostics data shows regional variation. From a diagnostics perspective, Orange Labs’ Bhamra said his labs “saw almost two-fold increase in allergy-related testing in Delhi-NCR, Mumbai and Hyderabad during October-December”, while Bengaluru did not register a similar increase. “Notably, the increase in testing volume in Hyderabad and Mumbai was higher than that in Delhi-NCR on a comparative basis,” he said, suggesting increased symptom awareness and proactive health-related behavior in these cities amid rising AQI.

According to an Agillus spokesperson, the testing trend is more pronounced in urban and peri-urban areas, especially in high-traffic areas, industrial belts and cities with known seasonal declines in AQI.

Respiratory insurance claims rise sharply in winter

Clinical and diagnostic trends are reflected in insurance data. ManipalCigna Health Insurance has recorded a substantial increase in respiratory claims during winter, with its six-year analysis showing that seasonal respiratory claims have increased by over 321 per cent between 2020 and 2024.

Tier-2 and tier-3 cities account for more than 84 per cent of all respiratory claims, indicating that pollution-related illness is no longer limited to big metros. Among tier-1 cities, Delhi-NCR contributes the highest share of respiratory claims at 6.5 per cent, followed by Bengaluru at 4.5 per cent and Mumbai at 4.2 per cent.

In 2024, respiratory conditions accounted for 18.8 percent of all seasonal winter disease-related claims, including COPD and asthma, followed by lung diseases caused by outdoor agents and acute respiratory distress syndrome – conditions that worsen during periods of high particle and toxic pollutant exposure.

PolicyBazaar data reinforces this pattern. Children account for 43 per cent of pollution-related health insurance claims, while the cost of treatment due to respiratory and cardiovascular issues has increased by 11 per cent. Pollution-related illnesses now account for more than eight percent of total hospitalization claims, with a sharp increase seen in the weeks following Diwali every year. Delhi leads in claim volume, while Bengaluru and Hyderabad show high claim ratio, and tier-2 cities like Jaipur, Lucknow and Indore are reporting rising case numbers.

As winter smog returns each year, the convergence of laboratory data and insurance claims is making it harder to ignore the health costs of air pollution – with children and the elderly bearing the greatest burden.