Burden of smoking related ill health in the UK

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Burden of smoking related ill health in the UK

• Ravi Balakrishnan
• BHF HPRG

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Background

• One of the biggest avoidable cause of morbidity
  and mortality
• Imposes a huge economic burden on the NHS.
• This paper provides an estimate of the current
  health and economic burden of smoking in the UK.
• Compares with previous studies and puts the cost
  of smoking in the context of other risks such as
  obesity and unhealthy nutrition.

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Methods
Systematic review Burden of disease
study Involved five steps They were

Step 1 Diseases attributed to smoking were
identified from the WHR 2002 Step 2 Data on
YLL, YLD, and DALYs -Euro A Region. Data on
mortality for the year 2005 was obtained directly
from ONS for England and Wales, and the GRO for
Scotland and NI. Step 3 Percent of total NHS
costs to smoking attributable conditions from DH
document (National Health Executive ,1996).
Total NHS expenditure for 2005-06 was taken from
DHs. Step 4 PAFs for smoking relevant to the
UK were extracted. These PAFs for smoking were
calculated against a theoretical population in
which all individuals had no tobacco use. Step
5 The burden of smoking was calculated by
applying the PAFs
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Results

• Table 1 Summary of studies included in review in
  the UK.

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Results cont..
Table 2 Proportion of deaths (mortality), YLLs,
YLDs and DALYs in WHO-EUR-A region 2002
Includes peptic ulcer disease and all
respiratory conditions except COPD Excluding
peptic ulcer disease
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Results cont..
Table 3 Percent of total DALYs lost attributable
to smoking related ill-health, by gender, in WHO
EUR-A region, 2002
Includes peptic ulcer disease and all
respiratory conditions except COPD and
Excluding peptic ulcer disease
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Results cont..
Table 4 Total deaths and deaths attributable to
smoking by gender and countries in the UK, in 2005
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Results cont..
Table 4 Percentage of total NHS costs
attributable to smoking for different diseases in
1992 - 93 and 2005 - 06 and cost
NHS Executive Burden of disease. A discussion
document. Wetherby Department of Health, 1996.
Includes peptic ulcer disease and all
respiratory conditions except COPD Excluding
peptic ulcer disease Attributable DALYs lost
within disease because of smoking as a percentage
of total DALYs lost to disease. NHS National
Health Service DALY disability adjusted life
years PAF population attributable fraction
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Discussion

• Deaths 2005
• 109,000 deaths (18.6 of all deaths) (M 27.2
  and F10.5).
• Twigg et al 19982002106,100 deaths (17.2
  M23F12).
• Callum et al 1995 120,000
• Royal College of Physicians1997 117,400
• Peto et al 2000 114,000
• Because of
• methodological differences,
• differing PAFs,
• changing contributions of other causes of death,
• changing prevalence of other risk factors,
• different resident population (57 million in 1991
  to 61 million in 2006 in the UK) and the year for
  which a mortality estimate is calculated.

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Discussion cont..

• NHS cost for smoking related ill health
• 2005-06 over 5 billion (5.5 of total health
  care cost)
• Parrott et al - 1991 between 1.4 to 1.5
  billion
• Buck et al -1991 between 1.4 and 1.7 billion
• 4.9 to 5.5 of total health care cost
• 11.8 (in the US) to 3.3 (in Germany)
• Because of
• 31 billion in 1991-92 to 80 billion in 2005-06
• Different PAFs used (used the same reference
  group)

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Discussion cont..

• Underestimated
• Firstly Indirect costs not included
• Secondly Burden due to passive smoking
• Thirdly Not considered all conditions related to
  smoking.
• Limitations
• Only conditions for which the WHR has PAFs were
  included.
• The absence of current NHS cost data by disease
  category, (extrapolated from 1992 data).
• Past burden of smoking.- because of its
  retrospective nature, and does not reflect the
  success or otherwise of recent and future
  interventions.

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Discussion cont..
Table 6 Burden of illhealth related to food,
physical inactivity, overweight / obesity,
smoking and alcohol misuse in terms of costs to
NHS and DALYs
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Conclusion

• Smoking still remains a considerable public
  health burden in the UK
• Accounting for 18.6 (109,164 deaths) of all
  deaths in 2005.
• Estimated direct cost to the NHS in 2005-06 was
  5.2 billion.
• To establishing the baseline
• To track its effects and to support the
  continuing smoking cessation services and other
  smoking related public health actions
• Helps policy makers to prioritise public health
  interventions and make effective use of limited
  NHS resource

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Thankyou