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Cited by 36Smoking Behavior and CessationHealthcare Policy and ManagementGlobal Health Care Issues

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

Open access
Lightwood, James, Glantz, Stanton A.·2016·PLOS Medicine
DOI 10.1371/journal.pmed.1002020PMC PMC4862673
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Abstract

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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Authors
Lightwood, J., & Glantz, S. A.
Affiliations
University of California, San Francisco (US)
Corresponding author
Glantz, Stanton A.
ORCID
Venue
PLOS Medicine
Publisher
Public Library of Science (PLoS)
Published
2016-05-10
Volume
13
Issue
5
Pages
e1002020
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1002020
PMC
PMC4862673
OpenAlex
W2374864284
Cited by
36
References
2
Citations by year
2025: 1 · 2024: 2 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 6 · 2019: 4 · 2018: 5 · 2017: 3 · 2016: 2
FWCI
3.76
Type
journal article
Language
en
Update notices
correction (2016-06-15)
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Cancer Institute (CA-61021)
Topics
  • Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Health Professions › General Health Professions › Global Health Care Issues
Keywords
smoking prevalence, health care expenditure, cigarette consumption, tobacco control, smoking restrictions, tobacco taxation, health care cost containment, state-level variation
MeSH terms
Cross-Sectional Studies, Health Expenditures, Humans, Public Health, Smoking, United States, Program Evaluation, Prevalence, Health Care Costs

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