Institute for Health & Aging, School of Nursing, University of California, San Francisco.
The Center for Tobacco Control Research and Education, University of California, San Francisco.
JAMA Netw Open. 2024 May 1;7(5):e2413869. doi: 10.1001/jamanetworkopen.2024.13869.
Cigarette smoking is a primary risk factor for chronic lower respiratory disease (CLRD) and is associated with worse symptoms among people with CLRD. It is important to evaluate the economic outcomes of smoking in this population.
To estimate smoking prevalence and cigarette smoking-attributable health care expenditures (SAHEs) for adults with CLRD in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the 2014-2018 and 2020 National Health Interview Surveys (NHIS) and the 2020 Medical Expenditure Panel Survey. The final study population, stratified by age 35 to 64 years and 65 years or older, was extracted from the 2014-2018 NHIS data. The data analysis was performed between February 1 and March 31, 2024.
Cigarette smoking, as classified into 4 categories: current smokers, former smokers who quit less than 15 years ago, former smokers who quit 15 or more years ago, and never smokers.
Smoking-attributable health care expenditures were assessed using a prevalence-based annual cost approach. Econometric models for the association between cigarette smoking and health care utilization were estimated for 4 types of health care services: inpatient care, emergency department visits, physician visits, and home health visits.
In the 2014-2018 NHIS study sample of 13 017 adults, 7400 (weighted 62.4%) were aged 35 to 64 years, 5617 (weighted 37.6%) were 65 years or older, and 8239 (weighted 61.9%) were female. In 2020, among 11 211 222 adults aged 35 to 64 with CLRD, 3 508 504 (31.3%) were current smokers and 3 496 790 (31.2%) were former smokers. Total SAHEs in 2020 for this age group were $13.6 billion, averaging $2752 per current smoker and $1083 per former smoker. In 2020, 7 561 909 adults aged 65 years or older had CLRD, with 1 451 033 (19.2%) being current smokers and 4 104 904 (54.3%) being former smokers. Total SAHEs in 2020 for the older age group were $5.3 billion, averaging $1704 per current smoker and $682 per former smoker. In sum, SAHEs for adults with CLRD aged 35 years or older amounted to $18.9 billion in 2020.
In this cross-sectional study of adults with CLRD, cigarette smoking was associated with a substantial health care burden. The higher per-person SAHEs for current smokers compared with former smokers suggest potential cost savings of developing targeted smoking cessation interventions for this population.
吸烟是慢性下呼吸道疾病（CLRD）的主要风险因素，与 CLRD 患者的症状恶化有关。评估该人群吸烟的经济后果很重要。
估计美国 CLRD 成年患者的吸烟流行率和与吸烟相关的医疗保健支出（SAHE）。
设计、设置和参与者：这项横断面研究使用了 2014-2018 年和 2020 年全国健康访谈调查（NHIS）以及 2020 年医疗支出面板调查的数据。最终的研究人群是从 2014-2018 年 NHIS 数据中按年龄 35 至 64 岁和 65 岁或以上分层提取的。数据分析于 2024 年 2 月 1 日至 3 月 31 日进行。
吸烟分为 4 类：当前吸烟者、戒烟不足 15 年的前吸烟者、戒烟 15 年或以上的前吸烟者和从不吸烟者。
使用基于患病率的年度成本法评估与吸烟相关的医疗保健支出。为 4 种类型的医疗保健服务（住院护理、急诊就诊、医生就诊和家庭保健就诊）估计了吸烟与医疗保健利用之间的关联的计量经济学模型。
在 2014-2018 年 NHIS 研究样本中，有 13017 名成年人，7400 名（加权 62.4%）年龄在 35 至 64 岁之间，5617 名（加权 37.6%）年龄在 65 岁或以上，8239 名（加权 61.9%）为女性。在 2020 年，在 11211222 名年龄在 35 至 64 岁的 CLRD 成年人中，有 3508504 名（31.3%）为当前吸烟者，3496790 名（31.2%）为前吸烟者。该年龄组 2020 年的总 SAHE 为 136 亿美元，当前吸烟者平均每人 2752 美元，前吸烟者平均每人 1083 美元。2020 年，有 7561909 名 65 岁或以上的成年人患有 CLRD，其中 1451033 名（19.2%）为当前吸烟者，4104904 名（54.3%）为前吸烟者。该年龄组 2020 年的总 SAHE 为 53 亿美元，当前吸烟者平均每人 1704 美元，前吸烟者平均每人 682 美元。总之，2020 年，35 岁或以上的 CLRD 成年患者的 SAHE 为 189 亿美元。
在这项针对 CLRD 成年患者的横断面研究中，吸烟与大量医疗保健负担有关。与前吸烟者相比，当前吸烟者的人均 SAHE 更高，这表明针对该人群开展有针对性的戒烟干预可能会节省成本。
