Abstract
Oregon Public Health Burden and Economic Costs of Tobacco Use in 2020
APHA 2022 Annual Meeting and Expo
Tobacco is the number-one cause of preventable mortality and morbidity in Oregon. This burden is not distributed equally, with the tobacco industry targeting populations facing systemic racism and other discrimination as well as lower-income populations. Many of these populations have not received adequate access to treatment or protection through public health policy interventions. Oregon Tobacco Prevention and Education Program (TPEP) has relied on the state-level CDC’s Smoking-Attributable Morbidity and Mortality Economic Costs (SAMMEC) to communicate the economic burden of tobacco use in Oregon and advocate for prevention policies and cessation support. SAMMEC does not provide community-scale estimates reflecting disparities in smoking rates and health baseline conditions among vulnerable populations.
We developed county-scale, age-, sex-, and race/ethnicity-specific population-attributable fractions using the most recent tobacco epidemiology studies for adult mortality and morbidity endpoints (including cancer, diabetes, respiratory, cardiovascular disease) and maternal smoking-related infant mortality and morbidity. We characterize impacts for several products (cigarette, cigar, non-combustible tobacco), current/former smokers, secondhand smoke. We use Oregon Behavioral Risk Factor Surveillance System 2014-2019 data, 2016-2019 vital statistics for adult mortality data, 2013-2018 vital statistics for live births-infant mortality data, 2015-2019 vital statistics for infant mortality data, and American Community Survey 2019 5-year population data. Economic burden of smoking-related mortality was represented by the present value of lost productivity estimated using American Time Use Survey 2019, CDC 2017 life tables, and 2020 Oregon wage data and assuming 3% discount rate. To assess economic burden of morbidity attributable to tobacco use, we implemented a new analysis of the Medical Expenditure Panel Survey 2010-2018 data to estimate the smoking-attributable incremental rate ratios for hospital visits and emergency room visits, along with the relative risk of exiting the labor market and a percent reduction in hours worked due to smoking-related illness. Economic burden of morbidity was assessed by combining these estimates with Oregon 2016-2020 hospital discharge data, Oregon 2018-2019 emergency room data, American Community Survey 2018 5-year labor market data.
This presentation overviews our key estimates of approximately 8,000 premature deaths, 162,000 disability-adjusted life years lost, 4,800 hospital stays, 7,300 emergency room visits, and $5.7 billion (2020 USD) in medical costs and lost productivity annually in Oregon. We share notable insights regarding the distribution across demographic groups; tobacco product types; use/exposure patterns; and disease causes. We discuss the sustainability of this analysis in Oregon and its feasibility in other states. Our results support Oregon TPEP’s outreach, planning, and communication efforts.