Pacific Institute for Research and Evaluation, Calverton, Maryland, USA.
School of Public Health, Curtin University, Perth, Western Australia, Australia.
BMJ Open. 2019 Jul 16;9(7):e026592. doi: 10.1136/bmjopen-2018-026592.
To assess the medical expenditures of American adults by their smoking status-Current, Former or Never smokers. We update these expenditures through 2015 controlling for personal characteristics and medical history and assess the impact of years-since-quitting and decade of life.
Weighted sample of American adults, 2011-2015. The linked National Health Interview Survey (NHIS) and Medical Expenditure Panel Survey (MEPS) are annual weighted representations of approximately 250 million adults. Sampling of NHIS is multistage with data collected throughout the year.
Using data from NHIS and MEPS, we collected demographic data, self-reported medical history and current smoking status. Smoking status was designated as Never, Current and Former, along with years-since-quitting. Total medical expenditures were collected from MEPS for 2011-2015. We used Manning's two-part model to estimate average expenditures per individual and marginal costs for individuals at all levels of smoking status.
American adults averaged US$4830 in average medical expenditures. Never smokers (US$4360, 95% CI 4154.3 to 4566.3), had lower expenditures than Current (US$5244, 95% CI 4707.9 to 5580.3) and Former (US$5590, 95% CI 5267.4 to 5913.5) smokers. CI for Current and Former smokers overlapped. Results were similarly significant when controlling for disease history. Years-since-quitting did not affect expenditures. In each decade of adult life, Former smokers had the highest annual medical expenditures, followed by Current and then Never smokers.
We updated annual medical expenditures during the Affordable Care Act era by smoking status using the current best practice model. While we identify Former smokers as having higher medical expenditures than Current smokers, we do not examine how care-seeking behaviour varies between levels of each risk factor.
评估美国成年人的医疗支出，依据其吸烟状况（当前吸烟者、曾经吸烟者或从不吸烟者）。我们通过控制个人特征和病史对这些支出进行了更新，并评估了戒烟年限和生命十年期的影响。
2011-2015 年美国成年人加权样本。国家健康访谈调查（NHIS）和医疗支出调查（MEPS）的链接是对大约 2.5 亿成年人进行年度加权的代表性调查。NHIS 的抽样是多阶段的，数据全年采集。
我们使用 NHIS 和 MEPS 的数据，收集了人口统计学数据、自我报告的病史和当前吸烟状况。吸烟状况被指定为从不吸烟、当前吸烟和曾经吸烟，以及戒烟年限。2011-2015 年从 MEPS 收集了总医疗支出数据。我们使用曼宁两部分模型估计了所有吸烟状况个体的人均平均支出和个体边际成本。
美国成年人的平均医疗支出为 4830 美元。从不吸烟者（4360 美元，95%置信区间 4154.3 至 4566.3）的支出低于当前吸烟者（5244 美元，95%置信区间 4707.9 至 5580.3）和曾经吸烟者（5590 美元，95%置信区间 5267.4 至 5913.5）。当前吸烟者和曾经吸烟者的置信区间重叠。在控制疾病史的情况下，结果同样显著。戒烟年限并未影响支出。在成年的每个十年期间，曾经吸烟者的年医疗支出最高，其次是当前吸烟者，然后是从不吸烟者。
我们使用当前最佳实践模型，根据吸烟状况更新了平价医疗法案时代的年度医疗支出。虽然我们发现曾经吸烟者的医疗支出高于当前吸烟者，但我们并未检查在每个风险因素水平下，寻求医疗服务的行为如何变化。
