Costs of medical care for acute myocardial infarction attributable to tobacco consumption.

BACKGROUND: Tobacco consumption is the principal modifiable risk factor causally associated with acute myocardial infarction (AMI). AMI has been an increasing and important cause of death in Mexico since 1980. METHODS: To estimate the direct health care costs of AMI, we carried out a cost of illness (COI) analysis, using data derived from an expert panel consensus and from medical chart review. We used the smoking attributable fraction (SAF) estimates to derive costs of tobacco consumption. We also estimated the benefits of a "Smoke-free Workplace" tobacco control policy in terms of avoidable deaths and health care costs savings. RESULTS: We estimated an annual average costs of 6,420 US dollars and 9,216 US dollars for non-ST segment elevation AMI (NSTEMI) and ST segment elevation AMI (STEMI), respectively. The total annual health care costs estimated for incident AMI for the IMSS state-level division of Morelos reached 2.9 million US dollars, of which 1.6 million US dollars was directly attributed to tobacco consumption. CONCLUSIONS: Our results confirm the high costs associated with smoking and show the potential benefits resulting from a tobacco control policy. Our estimates are only applicable to social security in the state-level division of Morelos and more likely represent a lower boundary of the total costs of cardiovascular diseases attributed to tobacco, because we based the costs estimation on incident cases, and we did not take into consideration the costs derived from prevalent cases, indirect costs or other intangibles.

[Health care costs attributable to tobacco consumption on a national level in the Mexican Social Security Institute]. / Costos de la atención médica atribuibles al consumo de tabaco en el Instituto Mexicano del Seguro Social.

OBJECTIVE: To estimate the cost of medical care for the major diseases attributable to tobacco consumption at the IMSS. MATERIAL AND METHODS: A cost of illness (COI) analysis was carried out from the perspective of the health provider. A random sample of clinical files (n= 1,596) was reviewed to estimate the human resources and medical supplies's utilization according to the health care facilities. The smoking attributable fraction (SAF) by disease was used to derive costs attributable to tobacco consumption. The unitary cost was valuated in 2004 Mexican pesos (MP). RESULTS: The estimated annual total cost of medical care was 7114 million MP for acute myocardial infarction (AMI); 3424 million MP for Cerebrovascular Disease, 1469 million MP for chronic obstructive pulmonary disease (COPD) and 102 million MP for lung cancer (LC). The annual total cost of medical care for IMSS was 12100 million MP. The total annual cost of medical care attributable to tobacco consumption corresponds to 7100 million MP, which is equivalent to 4.3% of the annual expenditures of the IMSS during 2004. CONCLUSIONS: These results confirm the high medical costs associated with smoking. This information would be used to reinforce the tobacco control preventive actions at IMSS and support decision-makers in strengthening public policies to control tobacco use in Mexico.

Costos de la atención médica atribuibles al consumo de tabaco en el Instituto Mexicano del Seguro Social / Health care costs attributable to tobacco consumption on a national level in the Mexican Social Security Institute

OBJETIVO: Cuantificar el efecto de las enfermedades atribuibles al consumo de tabaco, en términos epidemiológicos (morbilidad) y económicos (costos de atención médica), en el Instituto Mexicano del Seguro Social (IMSS) a escala nacional. MATERIAL Y MÉTODOS: Los costos de la atención médica se estimaron desde la perspectiva del proveedor y se empleó la metodología del costeo de enfermedad. A partir de una muestra de pacientes (n= 1 596) atendidos en las unidades médicas se estableció la frecuencia de utilización de servicios en los tres niveles de atención. Para cada enfermedad se consideraron costos promedio por paciente y costos totales de enfermedad, los cuales se mensuraron en pesos mexicanos de 2004. Se calculó la fracción atribuible al consumo de tabaco para cada enfermedad, misma que se usó para atribuir los costos al tabaco. RESULTADOS: Los costos totales anuales de atención médica nacional corresponden a 7 114 millones para el infarto agudo del miocardio, 3 424 millones para la enfermedad vascular cerebral, 1 469 millones para la enfermedad pulmonar obstructiva crónica y 102 millones para el cáncer pulmonar. El costo total anual para el IMSS por estas cuatro enfermedades asciende a 12 100 millones de pesos. Los costos atribuibles al consumo de tabaco corresponden a 7 100 millones de pesos, lo cual equivale a 4.3 por ciento del gasto de operación de la institución en el año 2004. CONCLUSIONES: Estos resultados confirman el elevado costo de la atención médica de las enfermedades atribuibles al consumo de tabaco en el IMSS y generan información de primera mano necesaria para impulsar las medidas de prevención en esa institución y reforzar las políticas de control del tabaquismo ya aplicadas en México.

Costos de atención médica atribuibles al tabaquismo en el IMSS, Morelos / Costs of medical care attributable to tobacco consumption at the Mexican Institute of Social Security (IMSS), Morelos

OBJETIVO: Estimar los costos de atención médica en el Instituto Mexicano del Seguro Social (IMSS), Delegación Morelos, de las enfermedades mayores atribuibles al consumo de tabaco. MATERIAL Y MÉTODOS: Las estimaciones de costos se realizaron desde la perspectiva del proveedor utilizando la metodología de costeo de enfermedad. Un panel de expertos multidisciplinario caracterizó la atención médica, en términos de la frecuencia de utilización de servicios en el primer y segundo niveles de atención, considerando el grado de severidad de la enfermedad. Los costos unitarios se estimaron en pesos mexicanos del 2001. Para estimar los costos atribuibles al tabaquismo se utilizó la fracción atribuible al consumo de tabaco para cada enfermedad (FA). RESULTADOS: Los costos promedio anuales de atención médica en el primer y segundo niveles de atención en la Delegación Morelos corresponden a 79 530 pesos para infarto agudo del miocardio (IAM), 73 303 pesos para enfermedad pulmonar obstructiva crónica (EPOC) y 102 215 pesos para cáncer de pulmón (CP). El costo total anual para la Delegación por estas tres enfermedades asciende a 147 millones 390 mil 688 pesos. Los costos atribuibles al consumo de tabaco corresponden a 124 millones de pesos, lo cual equivale a 7.3 por ciento del presupuesto anual de la Delegación. CONCLUSIONES: Estos resultados confirman el alto costo de la atención médica en el IMSS correspondiente a las enfermedades atribuibles al consumo de tabaco. Se recomienda realizar este estudio en el plano nacional, de tal manera que los tomadores de decisiones tengan herramientas para fortalecer las políticas de control del tabaquismo en México.

[Costs of medical care attributable to tobacco consumption at the Mexican Institute of Social Security (IMSS), Morelos]. / Costos de atención médica atribuibles al tabaquismo en el IMSS, Morelos.

OBJECTIVE: To estimate the cost of medical care for the major diseases attributable to tobacco consumption at the IMSS, Morelos. MATERIAL AND METHODS: A cost of illness (COI) analysis was carried out from the perspective of the health provider. An expert panel characterized medical care in primary and secondary care levels according to severity of disease. The smoking attributable fraction (SAF) by disease was used to derive costs attributable to tobacco consumption. The unitary cost was valuated in 2001 Mexican pesos (MP). RESULTS: The estimated annual average cost of medical care (diagnosis and first year of treatment) was 79,530 MP for acute myocardial infarction (AMI); 73,303 MP for chronic obstructive pulmonary disease (COPD); and 102,215 MP for lung cancer (LC). The annual total cost of medical care for IMSS was 147,390 688 MP. The total annual cost of medical care attributable to tobacco consumption corresponds to dollars 124 million MP, which is equivalent to 7.3% of the annual budget of the Morelos Delegation. CONCLUSIONS: These results confirm the high medical costs associated with smoking. A repetition of this study at the national level is recommended in order to support decision-makers in strengthening public policies to control tobacco use in Mexico.

Predictors of bone mineral density in female workers in Morelos State, Mexico.

BACKGROUND: Although several studies have identified factors associated with bone mineral density (BMD), little research is available on Mexican women. METHODS: A cross-sectional study was conducted in 1,622 female workers between 20 and 80 years of age at the Mexican Social Security Institute (IMSS), an integral part of the Mexican health system. It was carried out in Morelos, a Mexican state that borders Mexico City. Women were recruited to participate in this study from their workplaces. Body mass index (BMI) was measured and BMD was assessed using dual-energy x-ray absorptiometry of dominant forearm. Predictors of BMD (age, reproductive factors, BMI, diet, and physical activity) in pre- and postmenopausal women were assessed by questionnaire and analyzed using generalized additive models. RESULTS: In premenopausal women, older age, higher BMI, younger age at menarche, and greater vitamin D intake were associated with higher BMD (R(2)=0.06, null deviance reduction=6.9%). In postmenopausal women, determinants of BMD were older age, higher BMI, greater height, later initiation of menopause, longer time of use of hormonal replacement therapy (HRT), and greater calcium intake from dairy products (R(2)=0.39, null deviance reduction=40.7%). CONCLUSIONS: As observed in other populations, age, BMI, height, age at menopause, time of use of HRT, and calcium intake derived from dairy products in these Mexican women are factors associated with higher forearm BMD during postmenopausal period. Age, BMI, age at menarche, and vitamin D are associated with higher forearm BMD in premenopausal women. Some of these factors are not linearly associated with BMD. This was a limited population study carried out in a large group of female healthcare workers whose reproductive and lifestyle factors potentially agreed with those of female workers from urban areas of Mexico.