Health Care Utilization and Expenditures Attributable to Smokeless Tobacco Use Among US Adults
Health Care Utilization and Expenditures Attributable to Smokeless Tobacco Use Among US Adults
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DOI：
10.1093/ntr/ntx196
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发表时间：
2018-11-01
影响因子：
4.7
通讯作者：
Max, Wendy
中科院分区：
文献类型：
--
作者：
Wang, Yingning;Sung, Hai-Yen;Max, Wendy
引言：本研究估算了18岁及以上美国成年人因使用无烟烟草（包括嚼烟、鼻烟、蘸烟、口含烟和可溶解烟草）而产生的医疗保健利用情况和费用。
方法：我们使用2012 - 2015年全国健康访谈调查（n = 139451名成年人）的数据，针对美国成年人的四种医疗保健利用指标（住院天数、急诊室就诊次数、医生就诊次数和家庭护理就诊次数），以烟草使用状况和其他协变量为函数，估算了一个零膨胀泊松（ZIP）回归模型。烟草使用状况分为四类：当前无烟烟草使用者、既往无烟烟草使用者、非无烟烟草使用者和从不使用烟草者。基于估算的ZIP模型，使用“超额利用”方法计算了可归因于无烟烟草的利用情况。然后将其乘以从2014年医疗支出小组调查数据估算出的单位成本，以得出可归因于无烟烟草的医疗保健费用。
结果：在2012 - 2015年期间，2.1%的成年人是当前无烟烟草使用者，7.7%是既往无烟烟草使用者。可归因于无烟烟草的医疗保健利用情况为每年68.1万住院天数、62.4万急诊室就诊次数和460万医生就诊次数（家庭护理就诊结果不显著）。这导致每年住院超额支出18亿美元、急诊室就诊0.7亿美元以及医生就诊0.9亿美元，总计超过34亿美元（以2014年美元计算）。
结论：需要全面的烟草控制政策和干预措施来减少无烟烟草的使用以及相关的医疗保健负担。
Introduction: This study estimated the health care utilization and expenditures attributable to the use of smokeless tobacco (ST) which includes chewing tobacco, snuff, dip, snus, and dissolvable tobacco among US adults aged 18 and older.Methods: We used data from the 2012-2015 National Health Interview Surveys (n = 139451 adults) to estimate a zero-inflated Poisson (ZIP) regression model on four health care utilization measures among US adults (hospital nights, emergency room [ER] visits, doctor visits, and home care visits) specified as a function of tobacco use status, and other covariates. Tobacco use status was classified into four categories: current ST users, former ST users, non-ST tobacco users, and never tobacco users. ST-attributable utilization was calculated based on the estimated ZIP model using an "excess utilization" approach. It was then multiplied by the unit cost estimated from the 2014 Medical Expenditures Panel Survey data to derive ST-attributable health care expenditures.Results: During 2012-2015, 2.1% of adults were current ST users and 7.7% were former ST users. ST-attributable health care utilization amounted to 681 000 hospital nights, 624000 ER visits, and 4.6 million doctor visits per year (home care visits results were not significant). This resulted in annual excess expenditures of $1.8 billion for hospitalizations, $0.7 billion for ER visits, and $0.9 billion for doctor visits, totaling over $3.4 billion (in 2014 dollars).Conclusion: Comprehensive tobacco control policies and interventions are needed to reduce ST use and the associated health care burden.