Lightwood James, Glantz Stanton A
School of Pharmacy, University of California, San Francisco, San Francisco, California, United States of America.
Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, United States of America.
PLoS Med. 2016 May 10;13(5):e1002020. doi: 10.1371/journal.pmed.1002020. eCollection 2016 May.
Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states.
State per capita healthcare expenditure is modeled as a function of current smoking prevalence, mean cigarette consumption per smoker, other demographic and economic factors, and cross-sectional time trends using a fixed effects panel data regression on annual time series data for each the 50 states and the District of Columbia for the years 1992 through 2009. We found that 1% relative reductions in current smoking prevalence and mean packs smoked per current smoker are associated with 0.118% (standard error [SE] 0.0259%, p < 0.001) and 0.108% (SE 0.0253%, p < 0.001) reductions in per capita healthcare expenditure (elasticities). The results of this study are subject to the limitations of analysis of aggregate observational data, particularly that a study of this nature that uses aggregate data and a relatively small sample size cannot, by itself, establish a causal connection between smoking behavior and healthcare costs. Historical regional variations in smoking behavior (including those due to the effects of state tobacco control programs, smoking restrictions, and differences in taxation) are associated with substantial differences in per capita healthcare expenditures across the United States. Those regions (and the states in them) that have lower smoking have substantially lower medical costs. Likewise, those that have higher smoking have higher medical costs. Sensitivity analysis confirmed that these results are robust.
Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment.
与美国其他地区的对照人群相比，亚利桑那州和加利福尼亚州吸烟率的下降已被证明与这些州人均医疗保健支出的减少有关。本文将该分析扩展至所有州，并估计了所有州吸烟行为总体指标变化所导致的医疗保健支出变化。
使用固定效应面板数据回归模型，将州人均医疗保健支出建模为当前吸烟率、每位吸烟者的平均香烟消费量、其他人口和经济因素以及横截面时间趋势的函数，该回归模型基于1992年至2009年期间50个州和哥伦比亚特区的年度时间序列数据。我们发现，当前吸烟率相对降低1%以及当前每位吸烟者平均吸烟包数相对降低1%，分别与人均医疗保健支出降低0.118%（标准误[SE]0.0259%，p<0.001）和0.108%（SE0.0253%，p<0.001）相关（弹性）。本研究结果受到总体观察数据分析局限性的影响，特别是此类使用总体数据且样本量相对较小的研究本身无法确立吸烟行为与医疗保健成本之间的因果关系。吸烟行为的历史区域差异（包括因州烟草控制计划、吸烟限制和税收差异产生的影响）与美国各地人均医疗保健支出的显著差异相关。吸烟率较低的那些地区（以及其中的州）医疗成本大幅降低。同样，吸烟率较高的地区医疗成本也较高。敏感性分析证实这些结果是稳健的。
吸烟行为发生变化后，医疗保健支出的变化很快就会显现。预计每个州吸烟率相对下降10%，次年医疗保健支出将减少630亿美元（按2012年美元计算）。减少吸烟的州和国家政策应成为短期医疗保健成本控制的一部分。
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