ABSTRACT
BACKGROUND: Although it is generally agreed that tobacco use poses an enormous public health problem, payment and reimbursement for smoking-cessation interventions by financially stretched national health systems remain controversial. OBJECTIVE: The purpose of this study was to estimate the number and cost of excess respiratory illness-related visits attributable to smoking among older adults in the United States. METHODS: The 1995 and 1996 National Ambulatory Medical Care Survey databases were analyzed to estimate attributable risk in the population by age, sex, and smoking status among adults 50 to 75 years of age. Cost estimates for ambulatory physician visits were based on data from a major New England insurer using combined 1995 and 1996 information. Cost estimates were then developed for patients who had a respiratory-illness related diagnosis. RESULTS: Smoking was responsible for 5.1% (1,358,565) and 5.7% (1,452,761) of respiratory illness-related physician visits in 1995 and 1996, respectively. The costs (in 1998 dollars) of physician visits attributable to smoking were $69,205,301 and $74,003,645 in 1995 and 1996, respectively. CONCLUSIONS: Smoking increases health services utilization related to respiratory illness, thereby substantially increasing health care costs. Smoking-cessation programs may help reduce physician office visits related to respiratory illness, as well as the overall societal burden of smoking.
