Estimates of smoking-attributable mortality and hospitalization in BC, 2002-2007

Impact of the use of small-area models on estimation of attributable mortality at a regional level

The objective of this study is to assess the impact of applying prevalences derived from a small-area model at a regional level on smoking-attributable mortality (SAM). A prevalence-dependent method was used to estimate SAM. Prevalences of tobacco use were derived from a small-area model. SAM and population attributable fraction (PAF) estimates were compared against those calculated by pooling data from three national health surveys conducted in Spain (2011-2014-2017). We calculated the relative changes between the two estimates and assessed the width of the 95% CI of the PAF. Applying surveys-based prevalences, tobacco use was estimated to cause 53 825 (95% CI: 53 182-54 342) deaths in Spain in 2017, a figure 3.8% lower obtained with the small-area model prevalences. The lowest relative change was observed in the Castile-La Mancha region (1.1%) and the highest in Navarre (14.1%). The median relative change between regions was higher for women (26.1%), population aged ≥65 years (6.6%), and cardiometabolic diseases (9.0%). The differences between PAF by cause of death were never greater than 2%. Overall, the differences between estimates of SAM, PAF, and confidence interval width are small when using prevalences from both sources. Having these data available by region will allow decision-makers to implement smoking control measures based on more accurate data.

Economic cost of tobacco smoking and secondhand smoke exposure at home in Thailand

IntroductionSmoking is an important public health concern. This study is the first that attempts to estimate the economic cost of smoking and secondhand smoke (SHS) exposure at home in Thailand.MethodA prevalence-based cost of illness approach following the guideline by WHO is employed.ResultIn 2017, the direct morbidity cost attributable to smoking and SHS exposure at home in Thailand was estimated to be at least US$265.97 million and US$23.66 million, respectively. Indirect morbidity costs from workday loss totalling US$25.04 million can be linked to smoking, while US$1.72 million was the result of SHS exposure at home. Smoking-attributable premature deaths resulted in an opportunity loss to the country equivalent to US$2.48 billion, while the figure was US$181.41 million for SHS exposure at home. Total years of life lost due to smoking and SHS-attributable premature deaths are estimated to have been at least 390 955 years for males and 82 536 years for females. The total economic cost from both types of tobacco exposure amounted to US$2.98 billion, equivalent to 17.41% of Thailand's current health expenditure or 0.65% of its gross domestic product in 2017.ConclusionSmoking imposed a substantial economic burden on Thailand in 2017. Seven per cent of this cost was imposed on non-smokers sharing a residence with smokers. Females bore 80% of this SHS-related cost. The findings call for prompt responses from public health agencies in Thailand to launch effective tobacco control policies.

Trend analysis of smoking-attributable hospitalizations in Thailand, 2007-2014

INTRODUCTION

Tobacco use is a major preventable risk factor for many noncommunicable diseases. Smoking-attributable mortality has been well described. However, the prevalence of smoking-attributable hospitalization (SAH) and associated costs have been less documented, especially in low- and middle-income countries. Our objective was to estimate the number of hospital admissions and expenditure attributable to tobacco use during 2007-2014 in Thailand.

METHODS

Hospitalization data between 2007 and 2014 were used for the analysis. SAHs were derived by applying smoking-attributable fractions, based on Thailand's estimates of smoking prevalence data and relative risks extracted from the published literature, to hospital admissions related to smoking according to the International Classification of Diseases version 10. Age-adjusted SAHs among adults age 35 and older were calculated. Joinpoint regression analysis was used to detect changes in trends among genders and geographical areas, based on annual per cent change (APC) and average annual per cent change (AAPC). Costs related to SAHs were also estimated.

RESULTS

During 2007-2014, among adults age 35 years and older, smoking accounted for almost 3.6 million hospital admissions, with attributable hospital costs calculated at more than US$572 million annually, which represents 16.8% of the national hospital budget. While the age-adjusted rate of SAHs had been relatively stable (AAPC=1.12), the age-adjusted rate of SAHs due to cancers increased significantly for both sexes (AAPC=2.33). Cardiovascular diseases related to smoking increased significantly among men (AAPC=2.5), whereas, COPD, the most common smoking-related conditions decreased significantly during 2011-2014 (APC= -7.21). Furthermore, more provinces in the northeastern and the southern regions where smoking prevalence was higher than the national average have a significantly higher AAPC of SAH than other parts of the country.

CONCLUSIONS

Smoking remains a significant health and economic burden in Thailand. Findings from this study pose compelling evidence for Thailand to advance tobacco control efforts to reduce the financial and social burden of diseases attributable to smoking.

Clinical, humanistic, and economic burden of chronic obstructive pulmonary disease (COPD) in Canada: a systematic review

Background

Chronic obstructive pulmonary disease (COPD) is a chronic, irreversible disease and a leading cause of worldwide morbidity and mortality. In Canada, COPD is the fourth leading cause of death. This systematic review was undertaken to update healthcare professionals and decision makers regarding the recent clinical, humanistic and economic burden evidence in Canada.

Methods

A systematic literature search was conducted in PubMed, EMBASE, and Cochrane databases to identify original research published January 2000 through December 2012 on the burden of COPD in Canada. Each search was conducted using controlled vocabulary and key words, with “COPD” as the main search concept and limited to Canadian studies, written in English and involving human subjects. Selected studies included randomized controlled trials, observational studies and systematic reviews/meta-analyses that reported healthcare resource utilization, quality of life and/or healthcare costs.

Results

Of the 972 articles identified through the literature searches, 70 studies were included in this review. These studies were determined to have an overall good quality based on the quality assessment. COPD patients were found to average 0–4 annual emergency department visits, 0.3–1.5 annual hospital visits, and 0.7–5 annual physician visits. Self-care management was found to lessen the overall risk of emergency department (ED) visits, hospitalization and unscheduled physician visits. Additionally, integrated care decreased the mean number of hospitalizations and telephone support reduced the number of annual physician visits. Overall, 60–68 % of COPD patients were found to be inactive and 60–72 % reported activity restriction. Pain was found to negatively correlate with physical activity while breathing difficulties resulted in an inability to leave home and reduced the ability to handle activities of daily living. Evidence indicated that treating COPD improved patients’ overall quality of life. The average total cost per patient ranged between CAN $2444–4391 from a patient perspective to CAN $3910–6693 from a societal perspective. Furthermore, evidence indicated that COPD exacerbations lead to higher costs.

Conclusions

The clinical, humanistic and economic burden of COPD in Canada is substantial. Use of self-care management programs, telephone support, and integrated care may reduce the overall burden to Canadian patients and society.