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Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates

BACKGROUND: Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expen...

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Autores principales: Lightwood, James, Glantz, Stanton A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862673/
https://www.ncbi.nlm.nih.gov/pubmed/27163933
http://dx.doi.org/10.1371/journal.pmed.1002020
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author Lightwood, James
Glantz, Stanton A.
author_facet Lightwood, James
Glantz, Stanton A.
author_sort Lightwood, James
collection PubMed
description BACKGROUND: Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states. METHODS AND FINDINGS: State per capita healthcare expenditure is modeled as a function of current smoking prevalence, mean cigarette consumption per smoker, other demographic and economic factors, and cross-sectional time trends using a fixed effects panel data regression on annual time series data for each the 50 states and the District of Columbia for the years 1992 through 2009. We found that 1% relative reductions in current smoking prevalence and mean packs smoked per current smoker are associated with 0.118% (standard error [SE] 0.0259%, p < 0.001) and 0.108% (SE 0.0253%, p < 0.001) reductions in per capita healthcare expenditure (elasticities). The results of this study are subject to the limitations of analysis of aggregate observational data, particularly that a study of this nature that uses aggregate data and a relatively small sample size cannot, by itself, establish a causal connection between smoking behavior and healthcare costs. Historical regional variations in smoking behavior (including those due to the effects of state tobacco control programs, smoking restrictions, and differences in taxation) are associated with substantial differences in per capita healthcare expenditures across the United States. Those regions (and the states in them) that have lower smoking have substantially lower medical costs. Likewise, those that have higher smoking have higher medical costs. Sensitivity analysis confirmed that these results are robust. CONCLUSIONS: Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment.
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spelling pubmed-48626732016-05-18 Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates Lightwood, James Glantz, Stanton A. PLoS Med Research Article BACKGROUND: Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states. METHODS AND FINDINGS: State per capita healthcare expenditure is modeled as a function of current smoking prevalence, mean cigarette consumption per smoker, other demographic and economic factors, and cross-sectional time trends using a fixed effects panel data regression on annual time series data for each the 50 states and the District of Columbia for the years 1992 through 2009. We found that 1% relative reductions in current smoking prevalence and mean packs smoked per current smoker are associated with 0.118% (standard error [SE] 0.0259%, p < 0.001) and 0.108% (SE 0.0253%, p < 0.001) reductions in per capita healthcare expenditure (elasticities). The results of this study are subject to the limitations of analysis of aggregate observational data, particularly that a study of this nature that uses aggregate data and a relatively small sample size cannot, by itself, establish a causal connection between smoking behavior and healthcare costs. Historical regional variations in smoking behavior (including those due to the effects of state tobacco control programs, smoking restrictions, and differences in taxation) are associated with substantial differences in per capita healthcare expenditures across the United States. Those regions (and the states in them) that have lower smoking have substantially lower medical costs. Likewise, those that have higher smoking have higher medical costs. Sensitivity analysis confirmed that these results are robust. CONCLUSIONS: Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment. Public Library of Science 2016-05-10 /pmc/articles/PMC4862673/ /pubmed/27163933 http://dx.doi.org/10.1371/journal.pmed.1002020 Text en © 2016 Lightwood, Glantz http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Lightwood, James
Glantz, Stanton A.
Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates
title Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates
title_full Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates
title_fullStr Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates
title_full_unstemmed Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates
title_short Smoking Behavior and Healthcare Expenditure in the United States, 1992–2009: Panel Data Estimates
title_sort smoking behavior and healthcare expenditure in the united states, 1992–2009: panel data estimates
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4862673/
https://www.ncbi.nlm.nih.gov/pubmed/27163933
http://dx.doi.org/10.1371/journal.pmed.1002020
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