The burden of smoking in Israel-attributable mortality and costs (2014).

Gary M Ginsberg,Haim Geva

doi:10.1186/2045-4015-3-28

Gary M Ginsberg, Haim Geva

Open Access

https://doi.org/10.1186/2045-4015-3-28

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Abstract

BackgroundTobacco use is the single most preventable cause of death, incurring huge resource costs in terms of treating morbidity and lost productivity. This paper estimates smoking attributable mortality (SAM) as health costs in 2014 in Israel.MethodsLongitudinal data on prevalence of smokers and ex-smokers were combined with diagnostic and gender specific data on Relative Risks (RR) to gender and disease specific population attributable risks (PAR). PAR was then applied to mortality and hospitalization data from 2011, adjusted by population growth to 2014 to calculate SAM and hospitalization days (SAHD) caused by active smoking. These were used as a base for calculating deaths, hospital days and costs attributable to passive smoking, smoking by pregnant women, residential fires and productivity losses based on international literature.ResultsThe lagged model estimated active SAM in Israel in 2014 to be 7,025 deaths. Cardio-vascular causes accounted for 45.0% of SAM, malignant neoplasms (39.2%) and respiratory diseases (15.5%). Lung cancer alone accounted for 24.1% of SAM. There were an estimated 793, 17 and 12 deaths from passive smoking, mothers-to-be smoking and residential fires. Total SAM is around 7,847 deaths (95% CI 7,698-7,997) in 2014.We estimated 319,231 active SAHD days (95% CI 313,135-325,326). Respiratory care accounted for around one-half of active SAHD (50.5%). Cardio-Vascular causes for 33.5% and malignant neoplasms (13.2%). Lung cancer only for 4.6%. Total SAHD was around 356,601 days including 36,049 days from passive smoking. Estimated direct acute care costs of 356,601 days in a general hospital amount to around 849 (95% CI 832–865) million NIS ($244 million). Non acute care costs amount to an additional 830 million NIS ($238 million). The total health service costs amount to 1,678 million NIS (95% CI 1,646-1,710) or $482 million, 0.2% of GNP. Productivity losses account for a further 1,909 million NIS ($548 million), giving an overall smoking related cost of 3,587 million NIS (95% CI 3,519-3,656) or $1,030 million, 0.41% of GNP).ConclusionsSmoking causes a considerable burden in Israel, both in terms of the expected 7,847 lives lost and the financial costs of around 3.6 million NIS ($1,030 million or 0.42% of GNP).

Highlights

Tobacco use is the single most preventable cause of death, incurring huge resource costs in terms of treating morbidity and lost productivity
The updated lagged model estimated active smoking attributable mortality (SAM) in Israel in 2014 to be 7,025 deaths, after taking into account an estimated 174 and four fewer deaths, due to the protective effects of smoking on Parkinson’s disease and endometrial cancers respectively (Table 2)
Cardio-vascular causes accounted for 45.0% of SAM, malignant neoplasms (39.2%) and respiratory diseases (15.5%)

Summary

Introduction

Tobacco use is the single most preventable cause of death, incurring huge resource costs in terms of treating morbidity and lost productivity. In Israel, the first estimate of smoking attributable mortality (SAM) was made for the 2001 National Gillon Commission to decrease damage from smoking [5]. This estimated 9,527 deaths from active smoking in 1999 and a further 1,385 deaths from passive or enforced smoking by foetuses, children, spouses and workmates. These estimates assumed a nine year lag period for each diagnosis, ignored elevated risks in ex-smokers and did not use age-specific risk categories

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