Ruff L K, Volmer T, Nowak D, Meyer A
Medizinische Klinik, UniversitätsKrankenhaus Eppendorf, Hamburg, Germany.
Eur Respir J. 2000 Sep;16(3):385-90. doi: 10.1034/j.1399-3003.2000.016003385.x.
Smoking is a high-risk behaviour affecting health and economic welfare of society. Thus it is important to quantify the economic burden smoking places on social institutions in Germany. Approximately 33.4% of the male and 20.4% of the female population are current smokers. This study investigates the health care costs of smoking based on 1996 figures, focusing on the seven most frequent diseases associated with the inhalation of tobacco smoke: chronic obstructive pulmonary disease (COPD, international classification of diseases (ICD) 490-491); lung cancer (ICD 162); stroke (ICD 434-438); coronary artery disease (ICD 410-414); cancer of the mouth and larynx (ICD 140-149, 161) and artherosclerotic occlusive disease (ICD 440). A data search was carried out on MEDLINE, the German Institute for Medical Documentation and Information, and the Internet as well as in databases of health insurance companies and the German Federal institute of statistics. Direct and indirect costs were calculated separately. The results estimate the total smoking related health care costs (attributable fraction due to smoking) for COPD to be 5.471 billion EURO (73%), for lung cancer 2.593 billion EURO (89%), for cancer of the mouth and larynx 0.996 billion EURO (65%), for stroke 1.774 billion EURO (28%), for coronary artery disease 4.963 billion EURO (35%) and for atherosclerotic occlusive disease 0.761 billion EURO (28%). The economic burden of smoking related health care costs for Germany is 16.6 billion EURO. Smoking is therefore responsible for 47% of the overall costs of these diseases (35.2 billion EURO). In the view of the high costs for smoking, of which almost 50% are due to respiratory disease, pneumologists should enhance their effort in primary, secondary and tertiary prevention.
吸烟是一种影响健康和社会经济福利的高风险行为。因此，量化吸烟给德国社会机构带来的经济负担非常重要。德国约33.4%的男性和20.4%的女性为当前吸烟者。本研究基于1996年的数据调查吸烟的医疗保健成本，重点关注与吸入烟草烟雾相关的七种最常见疾病：慢性阻塞性肺疾病（COPD，国际疾病分类（ICD）490 - 491）；肺癌（ICD 162）；中风（ICD 434 - 438）；冠状动脉疾病（ICD 410 - 414）；口腔和喉癌（ICD 140 - 149，161）以及动脉粥样硬化闭塞性疾病（ICD 440）。在医学文献数据库MEDLINE、德国医学文献与信息研究所、互联网以及健康保险公司和德国联邦统计局的数据库中进行了数据搜索。分别计算了直接成本和间接成本。结果估计，COPD与吸烟相关的总医疗保健成本（归因于吸烟的比例）为54.71亿欧元（73%），肺癌为25.93亿欧元（89%），口腔和喉癌为9.96亿欧元（65%），中风为17.74亿欧元（28%），冠状动脉疾病为49.63亿欧元（35%），动脉粥样硬化闭塞性疾病为7.61亿欧元（28%）。德国吸烟相关医疗保健成本的经济负担为166亿欧元。因此，吸烟占这些疾病总成本（352亿欧元）的47%。鉴于吸烟成本高昂，其中近50%归因于呼吸系统疾病，肺科医生应在一级、二级和三级预防方面加大力度。
