Miller V P, Ernst C, Collin F
Berkeley Economic Research Associates, CA 94705, USA.
Soc Sci Med. 1999 Feb;48(3):375-91. doi: 10.1016/s0277-9536(98)00344-x.
Medical care costs attributable to cigarette smoking are estimated using an econometric model of annual individual expenditures for four types of medical services: ambulatory, hospital, prescription drug, and other (which includes home health and durable medical equipment and excludes dental and mental health). The model follows the two-part specification of Duan et al. (1983). Estimation is carried out using the 1987 National Medical Expenditure Survey. Fitted values are used to calculate smoking-attributable fractions (SAFs) of expense by type of service and by age and gender category. The overall weighted average SAF is 6.54%. SAFs are generally largest for ambulatory and smallest for hospital expenses. They are larger for males and for the older age categories. The model is analyzed for heteroscedasticity and goodness of fit. Additional analysis using the National Health Interview Survey is conducted to test for the possible effect of not being able to include alcohol consumption in the primary model. A balanced repeated replication analysis is conducted to evaluate the variance of the SAFs. Variances are found to be acceptably small. An extension of the model to support evaluation of smoking-attributable costs for special populations such as individual states, and special insurance pools such as Medicaid recipients, is described. Results for the fifty states are presented. Conclusions and subjects for further research are discussed.
归因于吸烟的医疗费用是使用一个计量经济学模型来估算的，该模型针对四种医疗服务的年度个人支出：门诊、住院、处方药和其他（包括家庭保健和耐用医疗设备，不包括牙科和心理健康）。该模型遵循段等人（1983年）的两部分设定。使用1987年国家医疗支出调查进行估计。拟合值用于按服务类型、年龄和性别类别计算费用的吸烟归因比例（SAF）。总体加权平均SAF为6.54%。SAF通常在门诊费用方面最大，在住院费用方面最小。在男性和年龄较大的类别中，SAF更大。对该模型进行了异方差性和拟合优度分析。使用国家健康访谈调查进行了额外分析，以测试在主要模型中无法纳入酒精消费的可能影响。进行了平衡重复复制分析，以评估SAF的方差。发现方差小到可以接受。描述了该模型的扩展，以支持评估特殊人群（如各个州）和特殊保险池（如医疗补助接受者）的吸烟归因成本。给出了五十个州的结果。讨论了结论和进一步研究的主题。
