Smoking Linked to High Costs in Patients With Chronic Lower Respiratory Disease

Smoking is common in patients with chronic lower respiratory disease (CLRD), and an estimated $18.9 billion in health care expenditures — almost 10% of the total spent on CLRD — may result from cigarette smoking in patients with CLRD. These were among the findings of a study published in JAMA Network Open.

Researchers conducted a cross-sectional study to estimate health care costs associated with cigarette smoking in patients with CLRD, using an econometric model and prevalence-based annual cost analysis. The analysis was based on data from US National Health Interview Surveys (NHIS) for 2014 to 2018 and 2020, as well as the 2020 Medical Expenditure Panel Survey (MEPS) for patients with CLRD aged 35 years or older.

Patients were categorized by smoking status as current smokers, former smokers who quit less than 15 years ago, former smokers who quit 15 or more years ago, and never smokers. Health care use and expenditures were estimated for inpatient care, emergency department (ED) visits, physician visits, and home health visits.

A total of 13,017 adults (62% female) with CLRD were identified from the 2014 to 2018 NHIS data, with 62% aged 35 to 64 years and 38% aged 65 years or older.

Based on 2020 MEPS data, 18,773,131 US adults aged 35 years or older had CLRD, which included 11,211,222 (59.7%) aged 35 to 64 years and 7,561,909 (40.3%) aged 65 years or older. Prevalence of CLRD was 13.0% in those aged 65 years or older vs 9.1% in patients aged 35 to 64 years, and the overall health care expenditures were $202.2 billion.

Of the 1174 adults who were aged 35 to 64 years with CLRD in 2020, 31.3% currently smoked and 31.2% formerly smoked. In addition, of the 1192 adults aged 65 years or older with CLRD, 19.2% currently smoked and 54.3% formerly smoked.

Among patients aged 35 to 64 years, total smoking-attributable fractions (SAF) for patients who currently and formerly smoked were 22.4% for home health visits, 19.0% for inpatient care, 9.2% for ED visits, and 7.1% for physician visits. SAFs for current smoking were more than double those for former smoking for each category of health care usage. Individuals aged 65 years or older generally had lower SAFs for health care usage than those aged 35 to 64.

For adults aged 35 years or older with CLRD, the annual smoking-attributable health care expenditures (SAHEs) were $18.9 billion in 2020. SAHEs were higher in those aged 35 to 64 years compared with those aged 65 years and older ($13.6 billion vs $5.3 billion, respectively). Overall, patients with CLRDs who currently smoked accounted for 71.3% ($9.7 billion) of SAHEs and those who formerly smoked accounted for 28.7% ($3.9 billion). The average SAHE per smoking individual was $2752 for those who currently smoked and $1083 for those who formerly smoked.

In participants aged 65 years or older, inpatient care represented 47.4% of SAHEs ($2.5 billion). Additionally, 52.8% ($2.8 billion) of SAHEs in these older patients involved individuals who formerly smoked and 47.2% ($2.5 billion) involved patients who currently smoked. The average per-patient SAHE was $1704 for individuals who currently smoked, $1662 for those who smoked less than 15 years ago, and $682 for those who formerly smoked, regardless of when they quit.

Limitations include the use of self-reports for smoking status. In addition, the study authors did not estimate expenditures from secondhand smoke exposure, did not control for risk factors such as cannabis and e-cigarette use, and did not consider indirect costs of smoking.

Overall, said the study authors, “We found that 18.8 million adults aged 35 years or older had CLRD in 2020 and that their total health expenditures were $202.2 billion, of which $18.9 billion were attributed to cigarette smoking.” The researchers further noted that “Because many people with CLRD continued to smoke, our findings suggest potential cost savings of developing targeted smoking cessation interventions for this population.”

Disclosure: One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Pulmonology Advisor