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Lo WC, Hu TH, Shih CY, Lin HH, Hwang JS. Impact of Healthy Lifestyle Factors on Life Expectancy and Lifetime Health Care Expenditure: Nationwide Cohort Study. JMIR Public Health Surveill 2024; 10:e57045. [PMID: 39018094 PMCID: PMC11292159 DOI: 10.2196/57045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/20/2024] [Accepted: 05/17/2024] [Indexed: 07/18/2024] Open
Abstract
BACKGROUND The association between lifestyle risk factors and the risk of mortality and chronic diseases has been established, while limited research has explored the impact of healthy lifestyle factors on lifetime health care expenditure using longitudinal individual data. OBJECTIVE We aimed to determine the individual and combined effects of 5 healthy lifestyle factors on life expectancy and lifetime health care expenditure in Taiwan. METHODS Using data from the National Health Interview Survey cohort, 5 healthy lifestyle behaviors were defined and analyzed: nonsmoking, avoiding excessive alcohol consumption, engaging in sufficient physical activity, ensuring sufficient fruit and vegetable intake, and maintaining a normal weight. We used a rolling extrapolation algorithm that incorporated inverse probability of treatment weighting to estimate the life expectancy and lifetime health care expenditure of the study populations with and without healthy lifestyle factors. RESULTS A total of 19,893 participants aged ≥30 (mean age 48.8, SD 13.4) years were included, with 3815 deaths recorded during a median follow-up period of 15.6 years. The life expectancy and per capita estimated lifetime health care expenditures for the overall study population were 35.32 years and US $58,560, respectively. Multivariable-adjusted hazard ratios for all-cause mortality in participants adhering to all 5 healthy lifestyle factors, compared with those adhering to none, were 0.37 (95% CI 0.27-0.49). We found significant increases in life expectancy for nonsmokers (2.31 years; 95% CI 0.04-5.13; P=.03), those with sufficient physical activity (1.85 years; 95% CI 0.25-4.34; P=.02), and those with adequate fruit and vegetable intake (3.25 years; 95% CI 1.29-6.81; P=.01). In addition, nonsmokers experienced a significant reduction in annual health care expenditure (-9.78%; 95% CI -46.53% to -1.45%; P=.03), as did individuals maintaining optimal body weight (-18.36%; 95% CI -29.66% to -8.57%; P=.01). Overall, participants adhering to all 5 healthy lifestyle behaviors exhibited a life gain of 7.13 years (95% CI 1.33-11.11; P=.02) compared with those adhering to one or none, with a life expectancy of 29.19 years (95% CI 25.45-33.62). Furthermore, individuals adopting all 5 healthy lifestyle factors experienced an average annual health care expenditure reduction of 28.12% (95% CI 4.43%-57.61%; P=.02) compared with those adopting one or none. CONCLUSIONS Adopting a healthy lifestyle is associated with a longer life expectancy and a reduction of health care expenditure in Taiwanese adults. This contributes to a more comprehensive understanding of the impact of healthy lifestyle factors on the overall health and economic burden.
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Affiliation(s)
- Wei-Cheng Lo
- Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, New Taipei, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tsuey-Hwa Hu
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Cheng-Yu Shih
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsien-Ho Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Kypriotakis G, Kim S, Karam-Hage M, Robinson JD, Minnix JA, Blalock JA, Cui Y, Beneventi D, Kim B, Pan IW, Shih YCT, Cinciripini PM. Examining the Association between Abstinence from Smoking and Healthcare Costs among Patients with Cancer. Cancer Prev Res (Phila) 2024; 17:217-225. [PMID: 37940143 PMCID: PMC11097145 DOI: 10.1158/1940-6207.capr-23-0245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 09/26/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
Continuous tobacco use in patients with cancer is linked to substantial healthcare costs due to increased risks and complications, whereas quitting smoking leads to improved treatment outcomes and cost reductions. Addressing the need for empirical evidence on the economic impact of smoking cessation, this study examined the association between smoking cessation and healthcare cost utilization among a sample of 930 patients with cancer treated at The University of Texas MD Anderson Cancer Center's Tobacco Research and Treatment Program (TRTP). Applying conditional quantile regression and propensity scores to address confounding, our findings revealed that abstinence achieved through the TRTP significantly reduced the median cost during a 3-month period post-quitting by $1,095 [β = -$1,095, P = 0.007, 95% confidence interval (CI), = (-$1,886 to -$304)]. Sensitivity analysis corroborated these conclusions, showing a pronounced cost reduction when outlier data were excluded. The long-term accrued cost savings from smoking cessation could potentially offset the cost of participation in the TRTP program, underscoring its cost effectiveness. An important implication of this study is that by reducing smoking rates, healthcare systems can more efficiently allocate resources, enhance patient health outcomes, and lessen the overall cancer burden. PREVENTION RELEVANCE This study emphasizes the dual impact of smoking cessation programs in patients with cancer: quitting smoking and reducing healthcare costs. It highlights the importance of integrating cessation programs into cancer prevention strategies, ensuring both individual health benefits and broader, system-wide economic efficiencies. See related Spotlight, p. 197.
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Affiliation(s)
- George Kypriotakis
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Seokhun Kim
- Center for Clinical Research and Evidence-Based Medicine, The University of Texas McGovern Medical School at Houston, Houston, TX
| | - Maher Karam-Hage
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jason D Robinson
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jennifer A Minnix
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Janice A Blalock
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yong Cui
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Diane Beneventi
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - I-Wen Pan
- Department of Health Services Research The University of Texas MD Anderson Cancer Center, Houston, Texas (All work on this manuscript was conducted prior to Dr. Pan’s departure from The University of Texas MD Anderson Cancer Center.)
| | - Ya-Chen Tina Shih
- Program in Cancer Health Economics Research, UCLA Jonsson Cancer Center and School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Paul M Cinciripini
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Lightwood JM, Anderson S, Glantz SA. Smoking and healthcare expenditure reductions associated with the California Tobacco Control Program, 1989 to 2019: A predictive validation. PLoS One 2023; 18:e0263579. [PMID: 36928830 PMCID: PMC10019627 DOI: 10.1371/journal.pone.0263579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/23/2022] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Previous research used data through 2008 to estimate a model for the effect of the California Tobacco Control Program (CTCP) that used cumulative real per capita tobacco control expenditure to predict smoking behavior (current adult smoking prevalence and mean cigarette consumption per current smoker). Predicted changes in smoking behavior due to the CTCP were used to predict its effect on health care expenditure. This research updates the model using the most recently available data and estimates CTCP program effect through 2019. METHODS The data used in the previous research were updated, and the original model specification and a related predictive forecast model were re-estimated. The updated regression estimates were compared to those previously published and used to update estimates of CTCP program effect in 2019 dollars. RESULTS There was no evidence of structural change in the previously estimated model. The estimated effect of the CTCP program expenditures on adult current smoking prevalence and mean consumption per adult current smoker has remained stable over time. Over the life of the program, one additional dollar per capita of program expenditure was associated with a reduction of current adult smoking prevalence by about 0.05 percentage point and mean annual consumption per adult current smoker by about 2 packs. Using updated estimates, the program prevented 9.45 (SE 1.04) million person-years of smoking and cumulative consumption of 15.7 (SE 3.04) billion packs of cigarettes from 1989 to 2019. The program produced cumulative savings in real healthcare expenditure of $544 (SE $82) billion using the National Income and Product Accounts (NIPA), and $816 (SE $121) billion using the Center for Medicare and Medicaid Services (CMS) measure of medical costs. During this time, the CTCP expenditure was $3.5 billion. CONCLUSION A simple predictive model of the effectiveness of the CTCP program remained stable and retains its predictive performance out-of-sample. The updated estimates of program effect suggest that CTCP program has retained its effectiveness over its 31-year life and produced a return on investment of 231 to 1 in direct CMS medical expenditure.
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Affiliation(s)
- James M. Lightwood
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Steve Anderson
- JPMorgan Chase & Co., San Francisco, California, United States of America
- Analytical Steve Consulting, San Francisco, California, United States of America
| | - Stanton A. Glantz
- Department of Medicine, Center for Tobacco Control Research and Education, Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
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Alnimer Y, Ali MKM. Predictors of Secondary Lung Cancer Among Hodgkin Lymphoma Survivors: A Nationwide Analysis. Clin Lung Cancer 2022; 23:e510-e518. [PMID: 36008241 DOI: 10.1016/j.cllc.2022.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/21/2022] [Accepted: 08/03/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE There is insufficient data regarding the incidence rate of secondary lung cancer among Hodgkin lymphoma (HL) survivors and the predisposing factors. METHODS We analyzed the data from the cohort of patients who had HL between 1973 and 2015 using the Surveillance Epidemiology and End Results database (SEER). Data on patient's age, gender, year of diagnosis with HL, Ann-Arbor stage, Histology, racial groups, date of last follow-up, date of death, and treatment modalities were collected. RESULTS We identified a total of 56,856 patients with HL; of those, 862 had secondary lung cancer, with an incidence rate of 157 (95%CI: 147-168) per 100,000 person-years. The median overall survival from time of HL diagnosis for those with secondary lung cancer was 12.1 years (95% CI: 10.7-13) compared to 27.1 years (95% CI: 26.5-27.6) for those who did not develop lung cancer (log-rank P-value of <.01). After propensity score weighting, radiation therapy was associated with a higher risk of secondary lung cancer (hazard ratio (HR): 1.23, 95% CI: 1.002-1.55) with a P-value of 0.048. Older age at the time of HL diagnosis and male gender were associated with higher risk, with an HR of 1.07 (95% CI 1.062-1.073) and an HR of 1.602 (95% CI 1.33-1.94), respectively. Furthermore, chemotherapy increased the risk only among older age groups. CONCLUSION Older age at the time of HL diagnosis, male gender, radiation therapy, and chemotherapy only among older age groups were associated with higher risk for secondary lung cancer, with 50% of the cases occurring within 9.1 years following HL diagnosis.
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Affiliation(s)
- Yanal Alnimer
- Hospital Medicine, Virginia Commonwealth University, Richmond, VA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Moaath K Mustafa Ali
- University of Maryland Greenebaum Comprehensive Cancer Center, Baltimore, MD; Hematology and Medical Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH
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DeCicca P, Kenkel D, Lovenheim MF. The Economics of Tobacco Regulation: A Comprehensive Review. JOURNAL OF ECONOMIC LITERATURE 2022; 60:883-970. [PMID: 37075070 PMCID: PMC10072869 DOI: 10.1257/jel.20201482] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Tobacco regulation has been a major component of health policy in the developed world since the UK Royal College of Physicians' and the US Surgeon General's reports in the 1960s. Such regulation, which has intensified in the past two decades, includes cigarette taxation, place-based smoking bans in areas ranging from bars and restaurants to workplaces, and regulations designed to make tobacco products less desirable. More recently, the availability of alternative products, most notably e-cigarettes, has increased dramatically, and these products are just starting to be regulated. Despite an extensive body of research on tobacco regulations, there remains substantial debate regarding their effectiveness, and ultimately, their impact on economic welfare. We provide the first comprehensive review of the state of research in the economics of tobacco regulation in two decades.
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Hajek A, König HH. Association between purpose in life and healthcare use among women and men in Germany: cross-sectional analysis of the nationally representative German Socio-Economic Panel (GSOEP) study. BMJ Open 2022; 12:e061525. [PMID: 35710240 PMCID: PMC9207899 DOI: 10.1136/bmjopen-2022-061525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES It remains almost unknown whether purpose in life is associated with healthcare use (HCU) in general. Therefore, the goal of this study was to examine the association between purpose in life and HCU (in terms of frequency of outpatient physician visits and hospitalisation) stratified by sex. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS A representative sample of the general adult population in Germany (n=1238; collected from September 2020 to February 2021); taken from the innovation sample of the German Socio-Economic Panel. OUTCOME MEASURES The frequency of outpatient physician visits in the past 3 months was used as first outcome measure. Hospitalisation in the last 12 months was used as the second outcome measure. Purpose in life was quantified by means of the subscale 'purpose in life' of the six-factor model of psychological well-being. Covariates were selected based on the Andersen model. RESULTS Average purpose in life equaled 4.5 (SD: 0.8; ranging on a scale from 1 to 6, with higher values indicating higher purpose in life). Adjusting for various potential confounders, regressions revealed that higher purpose in life was associated with an increased frequency of outpatient physician visits in the past 3 months among women (IRR 1.16, 95% CI:1.03 to 1.30), but not men (IRR 0.96, 95% CI 0.87 to 1.07). In contrast, higher purpose in life was associated with in an increased likelihood of hospitalisation among men (OR 1.40, 95% CI 1.02 to 1.93), but not women (OR 1.03, 95% CI 0.79 to 1.34). CONCLUSION Even after adjusting for various potential confounders, there was still a gender-specific association between higher purpose in life and increased HCU. This knowledge may assist in addressing individuals at risk for underuse or overuse of healthcare services.
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Affiliation(s)
- André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Hamburg, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Hamburg, Hamburg, Germany
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Ciccarelli C, De Fraja G, Vuri D. Effects of passive smoking on prenatal and infant development: Lessons from the past. ECONOMICS AND HUMAN BIOLOGY 2021; 42:101002. [PMID: 33964646 DOI: 10.1016/j.ehb.2021.101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 06/12/2023]
Abstract
This paper studies the effect of passive smoking on child development. We use data from a time when the adverse effects of smoking on health were not known and when tobacco was not an inferior good. This allows us to disentangle the effect on foetuses and infants of smoking from that of other indicators of social and economic conditions. We exploit a set of unique longitudinal historical datasets defined at a detailed level of geographical disaggregation, namely the 69 Italian provinces. The datasets record precise information on the per capita consumption of tobacco products, the heights of twenty-year old conscripts in the second half of the 19th century Italy, and other relevant controls. We find a strong negative effect of smoking in the period immediately before and after birth on the height at age 20. Results are robust to changes in specification and consistent across the height distribution.
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Affiliation(s)
| | - Gianni De Fraja
- University of Nottingham, UK; Università di Roma Tor Vergata, Italy; CEPR, UK.
| | - Daniela Vuri
- Università di Roma Tor Vergata, Italy; IZA, Berlin, Germany.
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Reitsma MB, Kendrick PJ, Ababneh E, Abbafati C, Abbasi-Kangevari M, Abdoli A, Abedi A, Abhilash ES, Abila DB, Aboyans V, Abu-Rmeileh NME, Adebayo OM, Advani SM, Aghaali M, Ahinkorah BO, Ahmad S, Ahmadi K, Ahmed H, Aji B, Akunna CJ, Al-Aly Z, Alanzi TM, Alhabib KF, Ali L, Alif SM, Alipour V, Aljunid SM, Alla F, Allebeck P, Alvis-Guzman N, Amin TT, Amini S, Amu H, Amul GGH, Ancuceanu R, Anderson JA, Ansari-Moghaddam A, Antonio CAT, Antony B, Anvari D, Arabloo J, Arian ND, Arora M, Asaad M, Ausloos M, Awan AT, Ayano G, Aynalem GL, Azari S, B DB, Badiye AD, Baig AA, Bakhshaei MH, Banach M, Banik PC, Barker-Collo SL, Bärnighausen TW, Barqawi HJ, Basu S, Bayati M, Bazargan-Hejazi S, Behzadifar M, Bekuma TT, Bennett DA, Bensenor IM, Berfield KSS, Bhagavathula AS, Bhardwaj N, Bhardwaj P, Bhattacharyya K, Bibi S, Bijani A, Bintoro BS, Biondi A, Birara S, Braithwaite D, Brenner H, Brunoni AR, Burkart K, Butt ZA, Caetano dos Santos FL, Cámera LA, Car J, Cárdenas R, Carreras G, Carrero JJ, Castaldelli-Maia JM, Cattaruzza MSS, Chang JC, Chen S, Chu DT, Chung SC, Cirillo M, Costa VM, Couto RAS, Dadras O, Dai X, Damasceno AAM, Damiani G, Dandona L, Dandona R, Daneshpajouhnejad P, Darega Gela J, Davletov K, Derbew Molla M, Dessie GA, Desta AA, Dharmaratne SD, Dianatinasab M, Diaz D, Do HT, Douiri A, Duncan BB, Duraes AR, Eagan AW, Ebrahimi Kalan M, Edvardsson K, Elbarazi I, El Tantawi M, Esmaeilnejad S, Fadhil I, Faraon EJA, Farinha CSES, Farwati M, Farzadfar F, Fazlzadeh M, Feigin VL, Feldman R, Fernandez Prendes C, Ferrara P, Filip I, Filippidis F, Fischer F, Flor LS, Foigt NA, Folayan MO, Foroutan M, Gad MM, Gaidhane AM, Gallus S, Geberemariyam BS, Ghafourifard M, Ghajar A, Ghashghaee A, Giampaoli S, Gill PS, Glozah FN, Gnedovskaya EV, Golechha M, Gopalani SV, Gorini G, Goudarzi H, Goulart AC, Greaves F, Guha A, Guo Y, Gupta B, Gupta RD, Gupta R, Gupta T, Gupta V, Hafezi-Nejad N, Haider MR, Hamadeh RR, Hankey GJ, Hargono A, Hartono RK, Hassankhani H, Hay SI, Heidari G, Herteliu C, Hezam K, Hird TR, Hole MK, Holla R, Hosseinzadeh M, Hostiuc S, Househ M, Hsiao T, Huang J, Iannucci VC, Ibitoye SE, Idrisov B, Ilesanmi OS, Ilic IM, Ilic MD, Inbaraj LR, Irvani SSN, Islam JY, Islam RM, Islam SMS, Islami F, Iso H, Itumalla R, Iwagami M, Jaafari J, Jain V, Jakovljevic M, Jang SI, Janjani H, Jayaram S, Jeemon P, Jha RP, Jonas JB, Joo T, Jürisson M, Kabir A, Kabir Z, Kalankesh LR, Kanchan T, Kandel H, Kapoor N, Karimi SE, Katikireddi SV, Kebede HK, Kelkay B, Kennedy RD, Khoja AT, Khubchandani J, Kim GR, Kim YE, Kimokoti RW, Kivimäki M, Kosen S, Koulmane Laxminarayana SL, Koyanagi A, Krishan K, Kugbey N, Kumar GA, Kumar N, Kurmi OP, Kusuma D, Lacey B, Lam JO, Landires I, Lasrado S, Lauriola P, Lee DW, Lee YH, Leung J, Li S, Lin H, Linn S, Liu W, Lopez AD, Lopukhov PD, Lorkowski S, Lugo A, Majeed A, Maleki A, Malekzadeh R, Malta DC, Mamun AA, Manjunatha N, Mansouri B, Mansournia MA, Martinez-Raga J, Martini S, Mathur MR, Medina-Solís CE, Mehata S, Mendoza W, Menezes RG, Meretoja A, Meretoja TJ, Miazgowski B, Michalek IM, Miller TR, Mirrakhimov EM, Mirzaei H, Mirzaei-Alavijeh M, Misra S, Moghadaszadeh M, Mohammad Y, Mohammadian-Hafshejani A, Mohammed S, Mokdad AH, Monasta L, Moni MA, Moradi G, Moradi-Lakeh M, Moradzadeh R, Morrison SD, Mossie TB, Mubarik S, Mullany EC, Murray CJL, Naghavi M, Naghshtabrizi B, Nair S, Nalini M, Nangia V, Naqvi AA, Narasimha Swamy S, Naveed M, Nayak S, Nayak VC, Nazari J, Nduaguba SO, Neupane Kandel S, Nguyen CT, Nguyen HLT, Nguyen SH, Nguyen TH, Nixon MR, Nnaji CA, Norrving B, Noubiap JJ, Nowak C, Ogbo FA, Oguntade AS, Oh IH, Olagunju AT, Oren E, Otstavnov N, Otstavnov SS, Owolabi MO, P A M, Pakhale S, Pakshir K, Palladino R, Pana A, Panda-Jonas S, Pandey A, Parekh U, Park EC, Park EK, Pashazadeh Kan F, Patton GC, Pawar S, Pestell RG, Pinheiro M, Piradov MA, Pirouzpanah S, Pokhrel KN, Polibin RV, Prashant A, Pribadi DRA, Radfar A, Rahimi-Movaghar V, Rahman A, Rahman MHU, Rahman MA, Rahmani AM, Rajai N, Ram P, Ranabhat CL, Rathi P, Rawal L, Renzaho AMN, Reynales-Shigematsu LM, Rezapour A, Riahi SM, Riaz MA, Roever L, Ronfani L, Roshandel G, Roy A, Roy B, Sacco S, Saddik B, Sahebkar A, Salehi S, Salimzadeh H, Samaei M, Samy AM, Santos IS, Santric-Milicevic MM, Sarrafzadegan N, Sathian B, Sawhney M, Saylan M, Schaub MP, Schmidt MI, Schneider IJC, Schutte AE, Schwendicke F, Seidu AA, Senthil Kumar N, Sepanlou SG, Seylani A, Shafaat O, Shah SM, Shaikh MA, Shalash AS, Shannawaz M, Sharafi K, Sheikh A, Sheikhbahaei S, Shigematsu M, Shiri R, Shishani K, Shivakumar KM, Shivalli S, Shrestha R, Siabani S, Sidemo NB, Sigfusdottir ID, Sigurvinsdottir R, Silva DAS, Silva JP, Singh A, Singh JA, Singh V, Sinha DN, Sitas F, Skryabin VY, Skryabina AA, Soboka M, Soriano JB, Soroush A, Soshnikov S, Soyiri IN, Spurlock EE, Sreeramareddy CT, Stein DJ, Steiropoulos P, Stortecky S, Straif K, Suliankatchi Abdulkader R, Sulo G, Sundström J, Tabuchi T, Tadakamadla SK, Taddele BW, Tadesse EG, Tamiru AT, Tareke M, Tareque MI, Tarigan IU, Temsah MH, Thankappan KR, Thapar R, Tichopad A, Tolani MA, Topouzis F, Tovani-Palone MR, Tran BX, Tripathy JP, Tsegaye GW, Tsilimparis N, Tymeson HD, Ullah A, Ullah S, Unim B, Updike RL, Vacante M, Valdez PR, Vardavas C, Varona Pérez P, Vasankari TJ, Venketasubramanian N, Verma M, Vetrova MV, Vo B, Vu GT, Waheed Y, Wang Y, Welding K, Werdecker A, Whisnant JL, Wickramasinghe ND, Yamagishi K, Yandrapalli S, Yatsuya H, Yazdi-Feyzabadi V, Yeshaw Y, Yimmer MZ, Yonemoto N, Yu C, Yunusa I, Yusefzadeh H, Zahirian Moghadam T, Zaman MS, Zamanian M, Zandian H, Zar HJ, Zastrozhin MS, Zastrozhina A, Zavala-Arciniega L, Zhang J, Zhang ZJ, Zhong C, Zuniga YMH, Gakidou E. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet 2021; 397:2337-2360. [PMID: 34051883 PMCID: PMC8223261 DOI: 10.1016/s0140-6736(21)01169-7] [Citation(s) in RCA: 621] [Impact Index Per Article: 207.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/15/2021] [Accepted: 05/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ending the global tobacco epidemic is a defining challenge in global health. Timely and comprehensive estimates of the prevalence of smoking tobacco use and attributable disease burden are needed to guide tobacco control efforts nationally and globally. METHODS We estimated the prevalence of smoking tobacco use and attributable disease burden for 204 countries and territories, by age and sex, from 1990 to 2019 as part of the Global Burden of Diseases, Injuries, and Risk Factors Study. We modelled multiple smoking-related indicators from 3625 nationally representative surveys. We completed systematic reviews and did Bayesian meta-regressions for 36 causally linked health outcomes to estimate non-linear dose-response risk curves for current and former smokers. We used a direct estimation approach to estimate attributable burden, providing more comprehensive estimates of the health effects of smoking than previously available. FINDINGS Globally in 2019, 1·14 billion (95% uncertainty interval 1·13-1·16) individuals were current smokers, who consumed 7·41 trillion (7·11-7·74) cigarette-equivalents of tobacco in 2019. Although prevalence of smoking had decreased significantly since 1990 among both males (27·5% [26·5-28·5] reduction) and females (37·7% [35·4-39·9] reduction) aged 15 years and older, population growth has led to a significant increase in the total number of smokers from 0·99 billion (0·98-1·00) in 1990. Globally in 2019, smoking tobacco use accounted for 7·69 million (7·16-8·20) deaths and 200 million (185-214) disability-adjusted life-years, and was the leading risk factor for death among males (20·2% [19·3-21·1] of male deaths). 6·68 million [86·9%] of 7·69 million deaths attributable to smoking tobacco use were among current smokers. INTERPRETATION In the absence of intervention, the annual toll of 7·69 million deaths and 200 million disability-adjusted life-years attributable to smoking will increase over the coming decades. Substantial progress in reducing the prevalence of smoking tobacco use has been observed in countries from all regions and at all stages of development, but a large implementation gap remains for tobacco control. Countries have a clear and urgent opportunity to pass strong, evidence-based policies to accelerate reductions in the prevalence of smoking and reap massive health benefits for their citizens. FUNDING Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.
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Ashare RL, Wileyto EP, Logue-Chamberlain E, Gross R, Tyndale RF, Lerman C, Hawk LW, Cinciripini P, George TP, Lubitz SF, Schnoll R. Patterns of lapses and recoveries during a quit attempt using varenicline and behavioral counseling among smokers with and without HIV. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 35:788-796. [PMID: 32686950 DOI: 10.1037/adb0000619] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Addressing tobacco use among HIV+ smokers is a priority. Lack of knowledge about how HIV+ smokers respond to tobacco use treatments limits our ability to effectively treat this population of smokers. Using data from 2 clinical trials that provided 12 weeks of varenicline and behavioral counseling, 1 with smokers with HIV (n = 89) and 1 with smokers without HIV (n = 179), we used mixed logistic regression modeling to compare point-prevalence abstinence rates and adherence to the initial target quit date (TQD) and Cox regression for repeated outcomes to evaluate lapse and recovery dynamics between the groups. Sixty percent of HIV- smokers refrained from smoking at the TQD while only 33% of HIV+ smokers did (odds ratio [OR] = 0.32, 95% CI [0.18, 0.56], p < .001). The point-prevalence abstinence rates at Week 12 were 31% (HIV-) and 28% (HIV+; OR = 0.7, 95% CI [0.42, 1.16], p = .16) and the point prevalence abstinence rates at Week 24 were 22% (HIV-) and 15% (HIV+; OR = 0.87, 95% CI [0.49, 1.57], p = .65). Although there was no interaction between HIV status and lapse risk, χ2(3) < 1, there was a significant interaction for the recovery model, (χ2(3) = 20.4, p < 0.001): as the number of events increased, the time to the next recovery became longer among smokers with HIV, compared to smokers without HIV. Although HIV+ smokers were treated effectively with varenicline, compared to HIV- smokers, they showed significantly lower initial cessation at the TQD and took increasingly longer to recover following lapses. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics and Division of Infectious Diseases
| | - Rachel F Tyndale
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health and Department of Pharmacology and Toxicology, and Division of Brain and Therapeutics
| | | | | | | | - Tony P George
- Addictions Division, Centre for Addiction and Mental Health and Division of Brain and Therapeutics
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Nadezhdin A, Joergenrud B, Tetenova E, Bryun E, Koshkina E, Petukhov A, Kolgashkin A, Kabashi S, Bogstrand ST. Predictors of tobacco smoking among acutely ill patients in a Moscow hospital: A cross-sectional study. Tob Prev Cessat 2020; 6:18. [PMID: 32548355 PMCID: PMC7291909 DOI: 10.18332/tpc/117954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/17/2020] [Accepted: 02/05/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Tobacco smoking is a major preventable risk factor for non-communicable diseases. The aim of this study was to investigate predictors of tobacco smoking among acute medically ill patients admitted to a Moscow hospital, and the association between smoking and alcohol use. METHODS Patients admitted to the V. P. Demikhov hospital in Moscow from November 2016 through December 2017 were asked to participate in this study (inclusion criteria were acute medically ill patients aged ≥18 years). Sociodemographic data were collected, in addition to questionnaires on mental distress (Hopkins Symptom Checklist 5), alcohol use (Alcohol Use Disorder Identification Test 4, AUDIT-4) and smoking (Fagerström Test for Nicotine Dependence). RESULTS A total of 3009 patients were recruited to the study. Using a binary logistic regression model adjusted for all variables, it was found that living without a partner resulted in a higher risk of smoking tobacco compared to being married or living with a partner (odds ratio, OR=1.60 for divorced, p=0.001; and OR=1.62 for single, p=0.002), and being economically non-active resulted in a higher risk compared to being economically active (OR=1.47; p=0.003). Harmful alcohol use (AUDIT-4 score ≥5 [for females] / 7 [for males]) resulted in a higher risk of smoking compared to those without harmful alcohol use (OR=4.04; p<0.001). CONCLUSIONS Smoking was highly prevalent and associated with other adverse sociodemographic and lifestyle factors such as harmful alcohol use.
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Affiliation(s)
- Aleksey Nadezhdin
- Moscow Research and Practical Centre on Addictions, Moscow Department of Public Health, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Ministry of Health, Moscow, Russia
| | | | - Elena Tetenova
- Moscow Research and Practical Centre on Addictions, Moscow Department of Public Health, Moscow, Russia
| | - Evgeny Bryun
- Moscow Research and Practical Centre on Addictions, Moscow Department of Public Health, Moscow, Russia.,Russian Medical Academy of Continuous Professional Education, Ministry of Health, Moscow, Russia
| | - Evgenya Koshkina
- Moscow Research and Practical Centre on Addictions, Moscow Department of Public Health, Moscow, Russia
| | - Alexei Petukhov
- Moscow Research and Practical Centre on Addictions, Moscow Department of Public Health, Moscow, Russia.,Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexey Kolgashkin
- Moscow Research and Practical Centre on Addictions, Moscow Department of Public Health, Moscow, Russia
| | - Saranda Kabashi
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Lightwood J, Anderson S, Glantz SA. Predictive validation and forecasts of short-term changes in healthcare expenditure associated with changes in smoking behavior in the United States. PLoS One 2020; 15:e0227493. [PMID: 31945079 PMCID: PMC6964879 DOI: 10.1371/journal.pone.0227493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 12/19/2019] [Indexed: 11/29/2022] Open
Abstract
Objectives Out-of-sample forecasts are used to evaluate the predictive adequacy of a previously published national model of the relationship between smoking behavior and real per capita health care expenditure using state level aggregate data. In the previously published analysis, the elasticities between changes in state adult current smoking prevalence and mean cigarette consumption per adult current smoker and healthcare expenditures were 0.118 and 0.108 This new analysis provides evidence that the model forecasts out-of-sample well. Methods Out-of-sample predictive performance was used to find the best specification of trend variables and the best model to bridge a break in survey data used in the analysis. Monte-Carlo simulation was used to calculate forecast intervals for the effect of changes in smoking behavior on expected real per capita healthcare expenditures. Results The model specification produced good-out-of-sample forecasts and stable recursive regression parameter estimates spanning the break in survey methodology. In 2014, a 1% relative reduction in adult current smoking prevalence and mean cigarette consumption per adult current smoker decreased real per capita healthcare expenditure by 0.104% and 0.113% the following year, respectively (elasticity). A permanent relative reduction of 5% reduces expected real per capita healthcare expenditures $99 (95% CI $44, $154) in the next year and $31.5 billion for the entire US (in 2014 dollars), holding other factors constant. The reductions accumulate linearly for at least five years following annual permanent decreases of 5% each year. Given the limitations of time series modelling in a relatively short time series, the effect of changes in smoking behavior may occur over several years, even though the model contains only one lag for the explanatory variables. Conclusion Reductions in smoking produce substantial savings in real per capita healthcare expenditure in short to medium term. A 5% relative drop in smoking prevalence (about a 0.87% reduction in absolute prevalence) combined with a 5% drop in consumption per remaining smoker (about 16 packs/year) would be followed by a $31.5 billion reduction in healthcare expenditure (in 2014 dollars).
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Affiliation(s)
- James Lightwood
- 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
| | - Steve Anderson
- JPMorgan Chase & Co., San Francisco, California, United States of America
- Analytical Steve Consulting, San Francisco, California, United States of America
| | - Stanton A. Glantz
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, United States of America
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
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Nolan MB, Borah BJ, Moriarty JP, Warner DO. Association between smoking cessation and post-hospitalization healthcare costs: a matched cohort analysis. BMC Health Serv Res 2019; 19:924. [PMID: 31791307 PMCID: PMC6889662 DOI: 10.1186/s12913-019-4777-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/22/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The potential economic benefit in terms of reduced healthcare costs when patients quit smoking after hospital discharge has not been directly measured. The aim of this study was to compare the costs for hospital admission and six-month follow-up for a cohort of patients who self-reported abstinence from cigarettes at 6 months after hospital discharge and a matched group of patients who reported continued smoking. MATERIALS AND METHODS This was a secondary analysis of a recent population-based clinical trial cohort (ClinicalTrials.gov ID: NCT01575145), with cohort membership determined by self-reported 7 day point prevalence abstinence at 6 months after the index hospital discharge. Participants were admitted to Mayo Clinic Hospital, Rochester, MN, between May 5, 2012 and August 10, 2014 for any indication and lived in the areas covered by postal codes included in Olmsted County, MN. Propensity score matching was used to control for differences between groups other than smoking status, and any residual imbalance was adjusted through generalized linear model with gamma distribution for cost and log-link transformation. RESULTS Of 600 patients enrolled in the clinical trial, 144 could be contacted and self-reported 7 day point prevalence abstinence at 6 months after hospital discharge. Of these patients, 99 were successfully matched for this analysis. The cost for the index hospitalization was significantly greater in patients who abstained compared to those that did not abstain (mean difference of $3042, higher for abstainers, 95% CI $170 to $5913, P = 0.038). However, there was no difference between mean 6-month follow-up costs, number of inpatient hospitalizations, or number of emergency room visits for abstainers versus non-abstainers. CONCLUSION There was no evidence to support the hypothesis that abstinence at 6 months after hospital discharge is associated with a decrease in health care costs or utilization over the first 6 months after hospital discharge.
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Affiliation(s)
- Margaret B Nolan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bijan J Borah
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - James P Moriarty
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Ashare RL, Thompson M, Serrano K, Leone F, Metzger D, Frank I, Gross R, Hole A, Mounzer K, Collman RG, Wileyto EP, Schnoll R. Placebo-controlled randomized clinical trial testing the efficacy and safety of varenicline for smokers with HIV. Drug Alcohol Depend 2019; 200:26-33. [PMID: 31082665 PMCID: PMC6588414 DOI: 10.1016/j.drugalcdep.2019.03.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND People living with HIV/AIDS (PLWH) smoke tobacco at higher rates and have more difficulty quitting than the general population, which contributes to significant life-years lost. The effectiveness of varenicline, one of the most effective tobacco dependence treatments, is understudied in HIV. We evaluated the safety and efficacy of varenicline for smoking cessation among PLWH. METHODS This was a single-site randomized, double-blind, placebo-controlled, phase 3 clinical trial (NCT01710137). PLWH on antiretroviral therapy (ART) who were treatment-seeking daily smokers were randomized (1:1) to 12 weeks of varenicline (n = 89) or placebo (n = 90). All participants were offered six smoking cessation behavioral counseling sessions. The primary outcome was 7-day point prevalence abstinence, confirmed with breath carbon monoxide, at Weeks 12 and 24. Continuous abstinence and time to relapse were secondary outcomes. Safety measures were treatment-related side effects, adverse events, blood pressure, viral load, and ART adherence. RESULTS Of the 179 smokers, 81% were African American, and 68% were male. Varenicline increased cessation at Week 12 (28.1% vs. 12.1%; OR = 4.54, 95% CI:1.83-11.25, P = .001). Continuous abstinence from Week 9 to 12 was higher for varenicline vs. placebo (23.6% vs. 10%; OR = 4.65, 95% CI:1.71-12.67, P = .003); at Week 24, there was no effect of varenicline for point prevalence (14.6% vs. 10%), continuous abstinence (10.1% vs. 6.7%), or time to relapse (Ps > .05). There were no differences between varenicline and placebo on safety measures (Ps > .05). CONCLUSIONS Varenicline is safe and efficacious for short-term smoking cessation among PLWH and should be used to reduce tobacco-related life-years lost in this population.
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Affiliation(s)
- Rebecca L Ashare
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA.
| | - Morgan Thompson
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
| | - Katrina Serrano
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
| | - Frank Leone
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania Presbyterian Medical Center, 51 N. 39th Street, Philadelphia, PA, USA
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
| | - Ian Frank
- Division of Infectious Diseases, University of Pennsylvania, 3610 Hamilton Walk, Philadelphia, PA, USA
| | - Robert Gross
- Division of Infectious Diseases, University of Pennsylvania, 3610 Hamilton Walk, Philadelphia, PA, USA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Anita Hole
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
| | - Karam Mounzer
- Philadelphia FIGHT, 1233 Locust Street, 3rd Floor, Philadelphia, PA, USA
| | - Ronald G Collman
- Pulmonary, Allergy and Critical Care Division, University of Pennsylvania, 522 Johnson Pavilion, 36th and Hamilton Walk, Philadelphia, PA, USA
| | - E Paul Wileyto
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Schnoll
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, Suite 4100, Philadelphia, PA, USA
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Glantz SA. Estimation of 1-Year Changes in Medicaid Expenditures Associated With Reducing Cigarette Smoking Prevalence by 1. JAMA Netw Open 2019; 2:e192307. [PMID: 30977860 PMCID: PMC6481435 DOI: 10.1001/jamanetworkopen.2019.2307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Reducing smoking is associated with a reduction in health care costs, including in the short run. Medicaid recipients smoke at higher rates than the general population, which suggests that investments to reduce smoking in this population would reduce short-run Medicaid costs. OBJECTIVE To estimate the short-run (1-year) change in health care expenditure associated with a 1% decrease in absolute smoking prevalence in all US states. DESIGN, SETTING, AND PARTICIPANTS Economic evaluation based on state Medicaid expenditures and the elasticity between changes in smoking prevalence and health care costs. Data sources were the 2017 Behavioral Risk Factors Surveillance System, 2017 National Health Interview Survey, and Kaiser Family Foundation Total Medicaid Spending for fiscal year 2017. Analysis was conducted in 2018. Participants were all people receiving Medicaid in all US states and the District of Columbia. EXPOSURES Cigarette smoking. MAIN OUTCOMES AND MEASURES Short-run (1-year) change in health care costs. RESULTS Reducing absolute smoking prevalence by 1% in each state was associated with substantial Medicaid savings the following year, totaling $2.6 billion (in 2017 dollars). Each state saved a median (interquartile range) of $25 million ($8 million to $35 million). CONCLUSIONS AND RELEVANCE Effective efforts to reducing smoking could be a cost-effective way to reduce Medicaid costs in the short run.
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Affiliation(s)
- Stanton A. Glantz
- Center for Tobacco Control Research and Education, Philip R. Lee Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco
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15
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DeHart WB, Kaplan BA, Pope DA, Mellis AM, Bickel WK. The experimental tobacco marketplace: Narrative influence on electronic cigarette substitution. Exp Clin Psychopharmacol 2019; 27:115-124. [PMID: 30394764 PMCID: PMC6445377 DOI: 10.1037/pha0000233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Despite promising decreases in overall smoking rates, a significant proportion of the population continues to engage in this costly behavior. Substituting e-cigarettes for conventional cigarettes is an increasingly popular harm-reduction strategy. Narratives may be one method of increasing the substitutability of e-cigarettes. Participants (N = 160) were assigned to 1 of 4 narratives that described a close friend becoming ill. In the positive narrative, participants read about a friend that became ill but learned it was only the flu. In the negative narrative, the friend became ill from smoking cigarettes; in the negativeregret narrative, the friend became ill from smoking cigarettes and explicitly expressed regret for having started smoking; and in the negativechange narrative, the friend became ill from smoking, switched to e-cigarettes, and made a full recovery. Participants then completed an experimental tobacco marketplace (ETM) in which they could purchase conventional cigarettes and alternative nicotine products, including e-cigarettes. Across ETM trials, the price of conventional cigarettes increased while the price of the alternative products remained constant. Initial purchasing of conventional cigarettes decreased and initial purchasing of e-cigarettes increased in the negative-change group compared with the other three groups. This finding was moderated by conventional cigarette dependence and perception of e-cigarette risk but not previous e-cigarette exposure. Narratives can change conventional cigarette and e-cigarette purchasing in an ETM that mimics real-world marketplaces. Narratives can be a valuable harm-reduction tool because they are cost-effective, can be widely disseminated, and can be personalized to individuals. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Kao YH, Celestin MD, Yu Q, Moody-Thomas S, Jones-Winn K, Tseng TS. Racial and Income Disparities in Health-Related Quality of Life among Smokers with a Quit Attempt in Louisiana. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E48. [PMID: 30781893 PMCID: PMC6410197 DOI: 10.3390/medicina55020048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/27/2019] [Accepted: 02/10/2019] [Indexed: 12/25/2022]
Abstract
Background and objectives: Smoking is associated with a lower health-related quality of life (HRQOL). However, there is little information about the association between HRQOL in relation to race, income, and smoking status. The present study aimed to assess the association between HRQOL and smoking status for those of different races and income levels. Materials and Methods: This study applied a cross-sectional design using data from the 2017 patient survey of the Louisiana Tobacco Control Initiative. We obtained 1108 responses from patients at eight Louisiana public hospitals. The EuroQol (EQ-5D) US index score assessed HRQOL. Smoking status was classified into four groups: never smoked, former smoker, current smoker with a quit attempt, and current smoker without a quit attempt. Multivariate linear regression analyses were used to estimate the HRQOL for black or African Americans and whites. Results: The patients were predominantly black or African American (58.9%) with lower-income (71.2%). Bivariate analyses showed that there were differences in income levels between black or African Americans and whites (p = 0.006). Moreover, black or African Americans (median = 0.80) had a higher mean of HRQOL than whites (median = 0.76). Among lower-income black or African Americans, current smokers with a quit attempt had a lower HRQOL than current smokers (coefficient = -0.12; p < 0.01). Conclusions: Racial and income disparities were evident with regards to HRQOL, with lower-income black or African Americans who were current smokers with a quit attempt having a lower HRQOL. Intervention programs for smoking cessation should target lower-income black or African American smokers who have a prior quit attempt and provide effective cessation services to help them quit smoking and improve their HRQOL.
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Affiliation(s)
- Yu-Hsiang Kao
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
| | - Michael D Celestin
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
| | - Qingzhao Yu
- Biostatistics, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
| | - Sarah Moody-Thomas
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
| | - Krysten Jones-Winn
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
| | - Tung-Sung Tseng
- Behavioral and Community Health Sciences, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA.
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Implementation phase of the Tobacco-Free Parks Ordinance: a policy evaluation using photographic data. Public Health 2018; 167:1-7. [PMID: 30502566 DOI: 10.1016/j.puhe.2018.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 10/12/2018] [Accepted: 10/18/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Mecklenburg County (Charlotte, North Carolina) Board of County Commissioners took the unique step of passing a Tobacco-Free Parks Ordinance designating most county parks as tobacco-free including all smoking products, smokeless tobacco, and e-cigarettes. The objective of the baseline phase of the Ordinance evaluation sought to assess whether signage in the parks was associated with the presence of tobacco-use litter. STUDY DESIGN A qualitative study was conducted with photography as the method of observation across Mecklenburg County parks in North Carolina. METHODS A representative sample of 42 parks was selected from the 186 county park properties. Photographs were taken at a list of specific types of locations within each park, with attention to signage and tobacco-use litter (butts, e-cigarette). RESULTS Tobacco-use evidence was mostly found in parks' picnic areas (67%) and walking trails (67%), with least found in parks' athletic courts (23%). At least 80% of parks have some tobacco litter. Evidence of tobacco use was not significantly associated with signage. CONCLUSION Little research has focused on the effect of local public policies limiting tobacco use in public outdoor spaces. Findings from this evaluation have potential to inform policy implementation efforts regarding efforts to limit tobacco use in public spaces.
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Nolan MB, Borah BJ, Moriarty JP, Warner DO. Economic Analysis of a Geographically Defined Cohort of Hospitalized Patients Who Smoke. Mayo Clin Proc 2018; 93:1034-1042. [PMID: 30078410 DOI: 10.1016/j.mayocp.2018.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/17/2018] [Accepted: 02/19/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare the indications for hospital admission between current, former, and never smokers and to compare their costs per hospital admission, testing the hypothesis that the cost per hospital admission would be higher for smokers than for former and never smokers. PATIENTS AND METHODS This study used a retrospective nested cohort design, with cohort membership determined by cigarette smoking status (current, former, or never). Propensity score-matching techniques were used to control for differences between groups other than smoking status. Participants were admitted to Mayo Clinic Hospital, Rochester, Minnesota, between May 5, 2012, and August 10, 2014, and lived in the areas covered by postal codes included in Olmsted County, Minnesota. RESULTS Compared with never smokers, a significantly higher proportion of admissions in current smokers were for diseases of the respiratory system, diseases of the circulatory system, infectious and parasitic diseases, mental illness, and injury or poisoning (P<.001 for all). The average cost per admission (without regard to admission indication) did not depend on smoking status. Accounting for dependence of admission indication on smoking status, there were no significant differences in costs between current and never smokers ($199 less per admission for current smokers; 95% CI -$820 to $423; P=.53) but costs in current smokers were actually significantly less than costs in former smokers (by -$870 per admission; 95% CI, -$1665 to -$76; P=.03). CONCLUSION There is no evidence that the cost of hospital admission is higher in current smokers than in never or former smokers, even when controlling for admission indication, in a general population of medical and surgical patients. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01575145.
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Affiliation(s)
- Margaret B Nolan
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
| | - Bijan J Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - James P Moriarty
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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Liutkutė V, Štelemėkas M, Veryga A. Smoking-Attributable Direct Healthcare Expenditure in Lithuania: A Prevalence-Based Annual Cost Approach. ACTA ACUST UNITED AC 2018; 54:medicina54020015. [PMID: 30344246 PMCID: PMC6037247 DOI: 10.3390/medicina54020015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/31/2018] [Accepted: 04/10/2018] [Indexed: 11/23/2022]
Abstract
Introduction: The estimates of the economic burden of smoking provide the basis for a comprehensive assessment of the overall economic impact and evidence for potential public health policy intervention by the government. The aim of this paper is to estimate the smoking-attributable direct healthcare expenditure covered by the Compulsory Health Insurance Fund (CHIF) in Lithuania in 2013. Methods: A prevalence-based and disease-specific annual cost approach was applied to 25 smoking-related diseases or disease categories. Our analysis included only direct government healthcare expenditure (reimbursed by CHIF), including: smoking-attributable outpatient and inpatient care services, medical rehabilitation, reimbursable and publicly procured pharmaceuticals and medical aids, the emergency medical aid (ambulance) service, nursing, and expensive tests and procedures. The smoking-attributable expenditure on the above-mentioned healthcare services was calculated by multiplying the total annual expenditure by the corresponding smoking attributable fractions (SAFs). Results: The total smoking-attributable government expenditure amounted to €37.4 million in 2013. This represented 3% of the total CHIF budget in 2013. Smoking-attributable expenditure on inpatient care and medical rehabilitation services was two times higher for male smokers, than for female smokers. Conclusions: Smoking imposes a significant preventable financial cost within the budget of the Lithuanian healthcare system. A quantitative estimation of smoking related healthcare costs could provide an incentive for the development of smoking cessation services, with additional attention towards male smokers, as well as an important focus on smoking prevention among children and youths.
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Affiliation(s)
- Vaida Liutkutė
- Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Tilžės g. 18, LT-47181 Kaunas, Lithuania.
| | - Mindaugas Štelemėkas
- Health Research Institute, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Tilžės g. 18, LT-47181 Kaunas, Lithuania.
| | - Aurelijus Veryga
- Ministry of Health of The Republic of Lithuania, Vilniaus g. 33, LT-01506 Vilnius, Lithuania.
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Baker CL, Ferrufino CP, Bruno M, Kowal S. Estimated Budget Impact of Adopting the Affordable Care Act's Required Smoking Cessation Coverage on United States Healthcare Payers. Adv Ther 2017; 34:156-170. [PMID: 27888437 PMCID: PMC5216065 DOI: 10.1007/s12325-016-0446-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice. This study presents current cessation patterns, real-world drug costs and plan benefit design data, and estimates the 1- to 5-year pharmacy budget impact of providing ACA-required coverage for smoking cessation products to understand the fiscal impact to a US healthcare plan. METHODS A closed cohort budget impact model was developed in Microsoft Excel® to estimate current and projected costs for US payers (commercial, Medicare, Medicaid) covering smoking cessation medicines, with assumptions for coverage and smoking cessation product utilization based on current, real-world national and state-level trends for hypothetical commercial, Medicare, and Medicaid plans with 1 million covered lives. A Markov methodology with five health states captures quit attempt and relapse patterns. Results include the number of smokers attempting to quit, number of successful quitters, annual costs, and cost per-member per-month (PMPM). RESULTS The projected PMPM cost of providing coverage for smoking cessation medications is $0.10 for commercial, $0.06 for Medicare, and $0.07 for Medicaid plans, reflecting a low incremental PMPM impact of covering two attempts ranging from $0.01 for Medicaid to $0.02 for commercial and Medicare payers. CONCLUSION The projected PMPM impact of covering two quit attempts with access to all seven cessation medications at no patient cost share remains low. Results of this study reinforce that the impact of adopting the ACA requirements for smoking cessation coverage will have a limited near-term impact on health plan's budgets. FUNDING Pfizer Inc.
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Abstract
[This corrects the article DOI: 10.1371/journal.pmed.1002020.].
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