Krueger Hans, Turner Donna, Krueger Joshua, Ready A Elizabeth
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada H. Krueger & Associates Inc., Delta, British Columbia, Canada.
Can J Public Health. 2014 Mar 18;105(1):e69-78. doi: 10.17269/cjph.105.4084.
Tobacco smoking, excess weight and physical inactivity contribute substantially to the preventable disease burden in Canada. The purpose of this paper is to apply a recently developed approach in addressing the issue of double counting in estimating the combined current economic burden of these risk factors (RFs) and to estimate the economic benefits of long-term RF reduction in Canada.
We used an approach based on population attributable fractions (PAF) to estimate the economic burden associated with the various RFs. Sex-specific relative risk and age-/sex-specific prevalence data were used in the modelling when available. Excess weight was modelled as a trichotomous exposure (normal weight, overweight, obese) while tobacco smoking was modelled as a tetrachotomous exposure (non-smoker, light, medium or heavy smoker). All costs are given in constant 2012 Canadian dollars.
The annual economic burden of the RFs of tobacco smoking, excess weight and physical inactivity in Canada are estimated at $50.3 billion in 2012. Sensitivity analysis suggests a range for the economic burden of $41.6 to $58.7 billion. Of the $50.3 billion, $21.3 ($20.0 to $22.6) billion is attributable to tobacco smoking, $19.0 ($13.8 to $24.0) billion to excess weight and $10.0 ($7.8 to $12.0) billion to physical inactivity. A 1% relative annual reduction in each of the three RFs would result in an $8.5 billion annual reduction in economic burden by 2031.
A modest annual 1% relative reduction in the RFs of tobacco smoking, excess weight and physical inactivity can have a substantial health and economic impact over time at the population level.
吸烟、超重和缺乏身体活动在很大程度上导致了加拿大可预防的疾病负担。本文的目的是应用一种最近开发的方法来解决在估计这些风险因素（RFs）当前综合经济负担时的双重计算问题，并估计加拿大长期降低风险因素带来的经济效益。
我们使用基于人群归因分数（PAF）的方法来估计与各种风险因素相关的经济负担。在建模时，如有可用数据，则使用按性别划分的相对风险以及按年龄/性别划分的患病率数据。超重被建模为三分暴露（正常体重、超重、肥胖），而吸烟被建模为四分暴露（不吸烟者、轻度、中度或重度吸烟者）。所有成本均以2012年不变加拿大元给出。
2012年，加拿大吸烟、超重和缺乏身体活动等风险因素的年度经济负担估计为503亿加元。敏感性分析表明经济负担范围在416亿至587亿加元之间。在这503亿加元中，213亿（200亿至226亿）加元可归因于吸烟，190亿（138亿至240亿）加元归因于超重，100亿（78亿至120亿）加元归因于缺乏身体活动。到2031年，这三种风险因素各自相对每年降低1%将导致经济负担每年减少85亿加元。
随着时间推移，吸烟、超重和缺乏身体活动等风险因素每年相对适度降低1%，在人群层面可产生重大的健康和经济影响。
