Commentary: Impact of smoking habit on medical care use and its costs

Abstract

The article by Yoko et al. 1 in this issue of the International Journal of Epidemiology estimates the excess medical care costs of smokers aged >45 years in Japan. The authors found that more than half (54.9%) of the men were current smokers and per capita medical costs for males was 11% higher than for never smokers. They conclude that 3.8% of total medical costs was attributable to smoking. The authors recognize that this proportion is low compared with that for the US, where the prevalence of smoking among adults is 26%, much lower than for males in Japan. The authors cite 7.1% of medical care costs was estimated to be attributable to smoking in the US. A later study 2 reported 11.8% of medical expenditures for people >19 years was attributable to smoking in the US. The authors wisely point out that although their estimates for Japan seem to be relatively small, the differences in the estimation methods and definition of medical care costs should be considered when making such comparisons between Japan and the US. It is important to note that this study by Yoko et al. is limited to estimates of the direct medical care costs attributable to smoking, thereby understating the total burden of smoking in Japan. In addition to the direct medical costs, the indirect costs of smoking should be added. These indirect costs of smoking include the value of lost productivity, output or forgone resources when people lose time from work and other productive activities due to morbidity, disability, or premature death caused by smoking-induced illnesses. One study in the US 3 reported that indirect costs of smoking amounted to more than the direct costs. These findings on the excess use of medical care services and the cost of smoking in Japan should be seen in the larger context of the global smoking epidemic. This devastating epidemic places an enormous burden on societies, including excess use of medical care services, loss of productivity for people unable to work or perform their usual activities, and premature deaths attributable to smoking. There are currently 1.1 billion smokers in the world; by