Department of Healthcare Economics and Quality Management, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Epidemiol. 2013;23(1):55-62. doi: 10.2188/jea.je20120072. Epub 2012 Nov 24.
The economic consequences of environmental tobacco smoke (ETS) have been simulated using models. We examined the individual-level association between ETS exposure and medical costs among Japanese nonsmoking women.
This population-based cohort study enrolled women aged 40 to 79 years living in a rural community. ETS exposure in homes at baseline was assessed with a self-administered questionnaire. We then collected health insurance claims data on direct medical expenditures from 1995 through 2007. Using generalized linear models with interaction between ETS exposure level and age stratum, average total monthly expenditure (inpatient plus outpatient care) per capita for nonsmoking women highly exposed and moderately exposed to ETS were compared with expenditures for unexposed women. We performed separate analyses for survivors and nonsurvivors.
We analyzed data from 4870 women. After adjustment for potential confounding factors, survivors aged 70 to 79 who were highly exposed to ETS incurred higher expenditures than those who were not exposed. We found no significant difference in expenditures between moderately exposed and unexposed women. Total expenditures were not significantly associated with ETS exposure among survivors aged 40 to 69 or nonsurvivors of any age stratum.
We calculated individual-level excess medical expenditures attributable to household exposure to ETS among surviving older women. The findings provide direct evidence of the economic burden of ETS, which is helpful for policymakers who seek to achieve the economically attractive goal of eliminating ETS.
已采用模型模拟环境烟草烟雾（ETS）的经济后果。我们检验了 ETS 暴露与日本不吸烟女性医疗费用之间的个体关联。
本基于人群的队列研究纳入居住在农村社区、年龄在 40 至 79 岁之间的女性。通过自填式问卷评估基线时家中的 ETS 暴露情况。然后，我们收集了 1995 年至 2007 年的医疗保险报销数据，用于直接医疗支出。使用包含 ETS 暴露水平与年龄层间交互作用的广义线性模型，比较高度和中度 ETS 暴露的不吸烟女性与未暴露女性的人均每月总支出（住院加门诊护理）。我们对幸存者和非幸存者分别进行了分析。
我们分析了 4870 名女性的数据。在调整了潜在混杂因素后，暴露于 ETS 的 70 至 79 岁幸存者的支出高于未暴露者。我们未发现中度暴露与未暴露女性之间的支出存在显著差异。在 40 至 69 岁的幸存者或任何年龄组的非幸存者中，总支出与 ETS 暴露均无显著关联。
我们计算了幸存的老年女性因家中暴露于 ETS 而导致的个体超额医疗支出。这些发现为决策者提供了 ETS 经济负担的直接证据，他们希望实现消除 ETS 这一具有经济吸引力的目标。
