Health and Economic Burden of Smoking in Missouri, 20002004

1
Health and Economic Burden of Smoking in
Missouri, 2000-2004

• Noaman Kayani, PhD
• Bureau of Health Informatics

2
Data Sources

• Missouri Behavioral Risk Factor Surveillance
  System (BRFSS), 2000-2004 (age- and
  gender-specific yearly prevalence of current and
  former smokers in Missouri)
• Missouri Death Records, 2000-2004 (age-, gender-
  and disease-specific number of deaths in each
  year, and the yearly gender-specific life
  expectancy)
• Missouri Birth Records, 2000-2004 (yearly
  maternal smoking prevalence)
  
• Missouri Medicaid Expenditure Data, 2005
  (smoking-attributable Medicaid healthcare
  expenditures in Missouri)

3
Methods

• Two Modules (adult and maternal and child health)
  of Smoking-Attributable Mortality, Morbidity and
  Economic Cost (SAMMEC) software were used to
  calculate
• Smoking-Attributable Mortality (SAM)
• Years of Potential Life Lost (YPLL)
• Productivity losses for adults

4
Is there any Health and Economic Burden of
Smoking?

• It is estimated that every year during 2000-2004
  
  
• 9,578 Missouri adults age 35 and older died
  prematurely due to smoking-related diseases
  
• 29 Infants died prematurely due to
  smoking-related diseases

5
9607 Deaths are an Under Estimation of
Smoking-Attributable Mortality (SAM) in Missouri

• It does not include deaths due to
• Second hand smoke (830-1470 deaths)
• Smoking related fires
• Use of other tobacco products
• Cigar
• Bidi
• Kretik
• Pipe
• Smokeless tobacco

Source Campaign for Tobacco Free Kids
6
Missouri SAM Breakup 2000-2004 (Annual Average)

• Men 5,800 deaths
• 22.1 of all deaths in men
• Women 3,778 deaths
• 13.3 of all deaths in women
• Total Adult 9,578 deaths
• 18.3 of all adult deaths
• Infants 29 deaths
• 16 male and 12 female
• (do not add up due to rounding)

7
Missouri Adult SAM by Disease Category, 2000-2004
8
Missouri SAM Resulting of Cancer, 2000-2004

• Cause of Death (ICD-10 Code) Deaths SAM YPLL
  PLoss
  
• Malignant Neoplasm
• Lip, Oral Cavity, Pharynx (C00-C14) 144
  95 1,611 37,312
  
• Esophagus (C15) 257 179 2,709 58,044
  
  
• Stomach (C16) 202 45 623 12,467
  
  
• Pancreas (C25) 636 153 2,300 45,692
• Larynx (C32) 77 62 974 21,179
  
  
• Trachea, Lung, Bronchus (C33-C34) 3,803 3,117
  46,197 903,844
  
• Cervix Uteri (C53) 77 11 272
  6,915
  
• Kidney and Renal Pelvis (C64-C65) 286
  77 1,168 25,739
  
• Urinary Bladder (C67) 241 102 1,181
  19,698
  
• Acute Myeloid Leukemia (C92.0) 161 28
  397 7,905
  
• Total 5,884 3,870
  57,433 1,138,797

9
Missouri SAM Resulting of Cardiovascular
Diseases, 2000-2004

• Cause of Death (ICD-10 Code)
  Deaths SAM YPLL PLoss
  
• Cardiovascular Diseases
• Ischemic Heart Disease 11,397 2,000
  29,094 604,179
  
• (I20-I25)
• Other Heart Disease 4,371 588 7,010
  121,499
  
• (I00-I09, I26-I51)
• Cerebrovascular Disease 3,690 396 6,086
  127,219
  
• (I00-I69)
• Atherosclerosis 292 44 365
  3,429
  
• (I70-I71)
• Aortic Aneurysm 319 190 2,215
  35,417
  
• (I71)
• Other Arterial Disease 245 37 455
  7,567
  
• (I72-I78)
• Total 20,314 3,256 45,225
  899,309

10
Missouri SAM Resulting of Respiratory Diseases,
2000-2004

• Cause of Death (ICD-10 Code) Deaths SAM YPLL
  PLoss
  
• Respiratory Diseases
• Pneumonia, Influenza 1,529 273 2,632
  32,943
  
• (J10-J18)
• Bronchitis, Emphysema 340 295 3,576
  55,884
  
• (J40-J42, J43)
• Chronic Airway Obstruction 2,395 1,884 21,046
  292,379
  
• (J44)
• Total 4,264 2,453 27,254 381,206

11
Missouri SAM Resulting of Perinatal Conditions,
2000-2004

• Cause of Death (ICD-10 Code) Deaths SAM
  YPLL
  
• Perinatal Conditions
• Short Gestation/Low Birth Weight 109 15
  1,114
  
• (P07)
• Sudden Infant Death Syndrome 56 11
  805
  
• (R95)
• Respiratory Distress (Syndrome)- 15 1
  45
  
• -newborn (P22)
• Other Respiratory Conditions-
• perinatal (P23-P28) 37 3 227
• Total 217 29 2,191

12
Three Leading Conditions/Diseases for Missouri
SAM, 2000-2004
13
Indirect Cost of Smoking, 2000-2004

• Annually, SAM Caused
• 132,103 Years of Potential Life Lost (YPLL)
  in Missouri
  
• 78,686 YPLL in men
• 53,417 YPLL in women

14
Economic Cost of SAM, 2000-2004(Average Annual)

• Smoking-attributable medical expenditures in
  Missouri 2.2 billion (in 2004 dollars)
  
• Productivity losses due to SAM 2.4 billion
• Total monetary cost 4.6 billion
• Smoking-attributable Medicaid cost 512 million
  (91 paid for by each Missouri resident)
  
• Total Medicaid-medical expenditures for 2005
• was 5.6 billion

15
Context

• Every hour a Missouri resident died due to
  smoking-related diseases
  
• SAM was 17.5 of all Missouri deaths and 18.3 of
  deaths among adults 35 years and older, in
  Missouri during 2000-2004
  
• SAM was more than twice the deaths from
  Accidents, AIDS, Homicide and Suicide combined

16
Missouri Compared to U.S.Adult Smoking
Prevalence, Trying to Quit and SAM
Source Behavioral Risk Factor Surveillance
System, 2004 and
2006 Data Highlights by CDC
17
Missouri Compared to U.S.Adult Smoking
Prevalence By Education and Income, 2004
Source Behavioral Risk Factor Surveillance
System, 2004 in
2006 Data Highlights by CDC
18
Missouri Compared to U.S.Adult Smoking
Prevalence By Age Group, 2004
Source Behavioral Risk Factor Surveillance
System, 2004 in
2006 Data Highlights by CDC
19
Missouri Compared to U.S.Exposure to Second Hand
Smoke Percent Protected By Non-Smoking Policies
(2001-2002)
Source Current Population Survey, 20012002, in
2006 Data Highlights by CDC Self-respondents
15 years and older who reported having a worksite
policy stating that smoking was not allowed
in indoor public or common areas and work areas.
Self-respondents 15 years and older who report
ed having a rule that smoking was not allowed
anywhere in their home.
20
The Status of U.S. Smoke-free Workplace
LegislationContinued- Exposure to Second Hand
Smoke
Note Information Updated in May 2007
(www.smokefree.net)
21
Missouri Compared to U.S.Continued- Exposure to
Second Hand Smoke Information Updated on April
2007 (www.smokefree.net)

• Communities With 100 Smoke-free Ordinances
• Missouri
• U.S.

with smoke-free ordinances

• Worldwide, the entire countries of Bhutan,
  England, Ireland, Italy, Malta, New Zealand,
  Northern Ireland, Norway, Scotland, Sweden,
  Uganda, Uruguay and Wales have enacted
  comprehensive smoke-free workplace legislation,
  including smoke-free restaurants and bars

22
Missouri Compared to U.S.Cigarette Price, State
Tax and Cigarette Consumption
Source Campaign for Tobacco Free Kids, and 2006
Data Highlights by CDC
23
Missouri Youth are in Danger of Dying from
Tobacco Use
At current rates, 140,000 of todays Missouri
youth are projected to die from tobacco-related
diseases
Source CDC. Projected Smoking-Related Deaths
Among YouthUnited States. MMWR 199645(44)
977-984 in 2006 Data Highlights by CDC
24
Missouri Compared to U.S.Youth Smoking
Prevalence, Numbers Projected to Start Smoking
and to Die from a smoking Related Condition
Youth Risk Behavior Surveillance System
CDC. Projected Smoking-Related Deaths Among
YouthUnited States. MMWR 199645(44)977-98
4
25
Missouri Youth Smoking RateGrade 6-12
The percentage of Missouri public school
students who reported smoking cigarettes on one
or more, of the 30 days prior to the survey.
Source Youth Tobacco Survey, 2005
26
What Do We Need to Do?

• Smoking among adults has declined significantly
  in states where comprehensive tobacco prevention
  programs were put in place during the early
  1990s, while Missouri rates remained relatively
  constant and above the national average.

Source Behavioral Risk Factor Surveillance
System, 1993-2005
27
What Do We Need to Do? Trend in Adult Smoking
Prevalence for Selected States Compared to U.S.,
1993-2005
Source Behavioral Risk Factor Surveillance
System, 1993-2005.
28

We Need to Spend What Experts Recommended for Us

• Centers for Disease Control and Prevention (CDC)
  
  
• recommends that Missouri spend between
• 43 and 120 million
• annually to implement a comprehensive tobacco
  prevention and cessation program.

Source CDC. (1999). Best Practices for
Comprehensive Tobacco Control Programs.
29
What We are Doing !!!!!!!!
30
How Much of Master Settlement Money is Being
Spent on Tobacco Control Efforts in Missouri?

• ø

31
Latest News What is going on?

• Quit line received highest number of calls in the
  nation from Missouri in April 2007 when state
  offered free Nicotine Replacement Therapy (NRT)
  to Uninsured and Medicaid Enrollees.
• This means Missourians want to quit smoking.
• Unfortunately, state stopped offering NRT due to
  lack of funding.

32
Summary

• Missouri suffers enormous human and financial
  losses from smoking.
  
• During 2000-2004, cigarette smoking resulted in
  more than one death per hour in Missouri.
  
• One out of every 6 deaths is smoking-related in
  Missouri
  
• Smokers life, on average, is shortened by about
  14 years in Missouri.
  

33
Recommendations

• More funding and efforts are needed to reduce
  this human and financial loss in the state.
  
• Policymakers, health professionals, and the
  general public should take additional steps to
  contain the tobacco epidemic in the State of
  Missouri.

34
Most Important Recommendation
X
35
If You Or Some One You Know Smokes?

• Recommendation
• Call for Help
• 1-800-QUIT-NOW

36
References

• Kayani NK, Yun S and Zhu, BP. The Health and
  Economic Burden of Smoking in Missouri, 2000-04,
  forthcoming in the May/June 2007 issue of
  Missouri Medicine.
• Missouri Department of Health and Senior
  Services. Missouri Vital Records, 2000-04.
  
• Centers for Disease Control and Prevention.
  Smoking-Attributable Mortality, Morbidity, and
  Economic Costs (SAMMEC) adult and maternal and
  child health software. Atlanta, GA US Department
  of Health and Human Services, CDC 2004.
• Sustaining State Programs for Tobacco Control
  Data Highlight, National Center for Chronic
  Disease Prevention and Health Promotion, United
  States Department of Health and Human Services
  2006. Available from http//www.cdc.gov/tobacco/d
  ata_statistics/state_data/data_highlights/2006/00_
  pdfs/DataHighlights06rev.pdf.

37
Continued--References

• Centers for Disease Prevention and Control.
  Behavioral Risk Factor Surveillance System
  1993-2005. Available from http//www.cdc.gov/brfs
  s/index.htm
• Campaign for Tobacco-Free Kids, (2005).
• Missouri 2005 Youth Tobacco Survey and CDC.
  (2005).
  
• Missouri Behavioral Risk Factor Surveillance
  System (BRFSS), 2000-2004.
  
• Missouri Medicaid Expenditure Data, 2005,
  Missouri Department of Social Services
  
• Centers for Disease Control and Prevention.
  (1999). Best Practices for Comprehensive Tobacco
  Control Programs.

38
Health and Economic Burden of Smoking in
Missouri, 2000-2004

• Authors
• Noaman Kayani, PhD
• Bureau of Health Informatics
• Shumei Yun, PhD, MD
• State Chronic Disease Epidemiologist
• Bao Ping Zhu, MD, MS
• State Epidemiologist, Missouri
• Acknowledgements
• Sherri Homan, PhD, RN
• Stan Cowan
• Maggie White
• Bureau of Health Promotion
• Bureau of Health Informatics

39

• Thank You
• Shukriya
• Merci
• Gracias