A prospective study of the costs of falls in older adults living in the community

OBJECTIVE: To establish the hospital cost and three-month, post-hospital community and personal costs associated with older adults discharged to the community after a fall. The timing, incidence and the determinants of these costs to the various sectors were also examined. METHODS: Patients who attended the Emergency. Department of a teaching hospital in Perth, Western Australia, were asked to complete a daily diary for three months of all community and informal care they received due to their fall and any associated expenses. Unit costs were collected from various sources and used to estimate the cost of community and informal care. Hospital inpatient costs were estimated using a patient-based costing system. RESULTS: Seventy-nine patients participated with a total estimated falls-related cost for the three-month period of $316,155 to $333,648 (depending on assumptions used) and a mean cost per patient of between $4,291 and $4,642. The hospital cost accounted for 80%, community costs 16% and personal costs 4% of the total. Of community and personal costs, 60% was spent in the first month. Type of injury was the most significant determinant of hospital and community costs. Extrapolating these figures to the WA population provided an estimate of the total hospital and three-month, post-hospital cost of falls of $24.12 million per year, with $12.1 million funded by the Federal Government, $10.1 million by State/local government and $1.7 million in out-of pocket expenses by patients. CONCLUSION: In the acute and immediate post-discharge period, hospital costs accounted for most of the cost of care for older adults discharged to the community after a fall. Community and personal costs, however, were also incurred. The cost estimates provide useful information for planners of hospital and community care for older people who have sustained a fall.     

Pediatric health care costs attributable to exposure to second-hand smoke: an exploratory analysis

Estimates of the excess health care costs from the exposure of children to tobacco smoke are not available in the United States. We use two nationally representative databases and current econometric techniques to estimate annual health care costs attributable to secondhand exposure by adults in the household. The point estimate closest to significance (p = .11) indicates annual smoking attributable costs equal $890 in 2003 dollars and approximately 2 percent of total annual neonatal and pediatric health care costs. Our inability to find a statistically significant effect appears driven by the negative relationship found between the child's exposure and any use/expense for the child. Unobserved caregiver characteristics are likely to be positively associated with smoking but negatively associated with children's health care utilization. This is consistent with evidence from observational studies that indicate adult smokers' lower orientation toward preventive care contributes to a decreased use of discretionary health services.     

Burden of disease and costs of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom

Background

To estimate life years and quality-adjusted life years (QALYs) lost and the economic burden of aneurysmal subarachnoid haemorrhage (aSAH) in the United Kingdom including healthcare and non-healthcare costs from a societal perspective.

Methods

All UK residents in 2005 with aSAH (International Classification of Diseases 10^th revision (ICD-10) code I60). Sex and age-specific abridged life tables were generated for a general population and aSAH cohorts. QALYs in each cohort were calculated adjusting the life tables with health-related quality of life (HRQL) data. Healthcare costs included hospital expenditure, cerebrovascular rehabilitation, primary care and community health and social services. Non-healthcare costs included informal care and productivity losses arising from morbidity and premature death.

Results

A total of 80,356 life years and 74,807 quality-adjusted life years were estimated to be lost due to aSAH in the UK in 2005. aSAH costs the National Health Service (NHS) £168.2 million annually with hospital inpatient admissions accounting for 59%, community health and social services for 18%, aSAH-related operations for 15% and cerebrovascular rehabilitation for 6% of the total NHS estimated costs. The average per patient cost for the NHS was estimated to be £23,294. The total economic burden (including informal care and using the human capital method to estimate production losses) of a SAH in the United Kingdom was estimated to be £510 million annually.

Conclusion

The economic and disease burden of aSAH in the United Kingdom is reported in this study. Decision-makers can use these results to complement other information when informing prevention policies in this field and to relate health care expenditures to disease categories.     

Passive smoking and its impact on employers and employees in Hong Kong

Aims: To estimate the prevalence of passive smoking at work in the whole workforce in Hong Kong (population 6.8 million), the characteristics of the passive smokers, any extra use of health care among passive smokers, and who pays for that health care.

Methods: A random sample of 14 325 households was contacted by telephone; 6186 responding adults who worked full time were asked about their employment, their most recent use of health care and the cost of that care, their medical benefits, and their exposure to secondhand smoke in the workplace. After weighting the sample for sex, age, household size, and income, 4739 subjects were included in the analysis.

Results: Of 1961 full time workers who did not smoke, 47.5% were exposed to secondhand smoke in the workplace compared with only 26% exposed at home. Exposure at work was associated with being younger, male, married, less educated, and having a lower income. Those exposed at work were 37% more likely to report having visited a doctor for a respiratory illness in the previous 14 days. Employers were paying 28% of the cost of these visits, the government paid 8%, and the individuals paid 63%. If extrapolated to the 3 million workers in the Hong Kong population, employers would pay just over US$9 million per year, while the affected workers would pay around US$20 million.

Conclusion: As well as the costs of active smoking, the cost of extra health care utilisation associated with passive smoking is an additional cost being paid by those employers who have not established smoke free workplaces and by their employees.

     

Costs of maternal conditions attributable to smoking during pregnancy

Context: Despite known adverse health effects, many women continue to smoke during pregnancy. Public attention has now focused on the economic as well as health effects of this behavior.Objective: To estimate health care costs associated with smoking-attributable cases of placenta previa, abruptio placenta, ectopic pregnancy, preterm premature rupture of the membrane (PPROM), pre-eclampsia, and spontaneous abortion.Design: Pooled odds ratios were used with data on total cases to estimate smoking-attributable cases. Estimated average costs for cases of ectopic pregnancy and spontaneous abortion were used to estimate smoking-attributable health care costs for these conditions. Incremental costs, or costs above those for a “normal” delivery, were used to estimate smoking-attributable costs of placenta previa, abruptio placenta, PPROM, and pre-eclampsia associated with delivery.Setting: National estimates for 1993.Participants: Data from the National Hospital Discharge Survey (NHDS) and claims data from a sample of large, self-insured employers across the country.Results: Smoking-attributable costs ranged from $1.3 million for PPROM to $86 million for ectopic pregnancy. Smoking during pregnancy apparently protects against pre-eclampsia and saves between $36 and $49 million, depending on smoking prevalence. Over all conditions smoking-attributable costs ranged from $135 to $167 million.Conclusions: Smoking during pregnancy is a preventable cause of higher health care costs for the conditions studied. While smoking during pregnancy was found to be protective against pre-eclampsia and, hence, saves costs, the net costs were still positive and significant. Effective smoking-cessation programs can reduce health care costs but clinicians will perhaps need to manage increased cases of pre-eclampsia in a cost-effective manner.     

Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991

This study presents three estimates--ranging from low to high--of the direct and indirect costs of the AIDS epidemic in the United States in 1985, 1986, and 1991, based on prevalence estimates provided by the Centers for Disease Control (CDC). According to what the authors consider their best estimates, personal medical care costs of AIDS in current dollars will rise from $630 million in 1985 to $1.1 billion in 1986 to $8.5 billion in 1991. Nonpersonal costs (for research, screening, education, and general support services) are estimated to rise from $319 million in 1985 to $542 million in 1986 to $2.3 billion in 1991. Indirect costs attributable to loss of productivity resulting from morbidity and premature mortality are estimated to rise from $3.9 billion in 1985 to $7.0 billion in 1986 to $55.6 billion in 1991. While estimated personal medical care costs of AIDS represent only 0.2 percent in 1985 and 0.3 percent in 1986 of estimated total personal health care expenditures for the U.S. population, they represent 1.4 percent of estimated personal health care expenditures in 1991. Similarly, while estimated indirect costs of AIDS represent 1.2 percent in 1985 and 2.1 percent in 1986 of the estimated indirect costs of all illness, they are estimated to rise to almost 12 percent in 1991. Estimates of personal medical care costs were based on data from various sources around the United States concerning average number of hospitalizations per year, average length of hospital stay, average charge per hospital day, and average outpatient charges of persons with AIDS. For estimating the indirect costs the human capital method was used, and it was assumed that average wages and labor force participation rates of persons with AIDS were the same as those for the general population by age and sex.     

The economic burden of occupational non-melanoma skin cancer due to solar radiation

Solar ultraviolet (UV) radiation is the second most prevalent carcinogenic exposure in Canada and is similarly important in other countries with large Caucasian populations. The objective of this article was to estimate the economic burden associated with newly diagnosed non-melanoma skin cancers (NMSCs) attributable to occupational solar radiation exposure. Key cost categories considered were direct costs (healthcare costs, out-of-pocket costs (OOPCs), and informal caregiver costs); indirect costs (productivity/output costs and home production costs); and intangible costs (monetary value of the loss of health-related quality of life (HRQoL)). To generate the burden estimates, we used secondary data from multiple sources applied to computational methods developed from an extensive review of the literature. An estimated 2,846 (5.3%) of the 53,696 newly diagnosed cases of basal cell carcinoma (BCC) and 1,710 (9.2%) of the 18,549 newly diagnosed cases of squamous cell carcinoma (SCC) in 2011 in Canada were attributable to occupational solar radiation exposure. The combined total for direct and indirect costs of occupational NMSC cases is $28.9 million ($15.9 million for BCC and $13.0 million for SCC), and for intangible costs is $5.7 million ($0.6 million for BCC and $5.1 million for SCC). On a per-case basis, the total costs are $5,670 for BCC and $10,555 for SCC. The higher per-case cost for SCC is largely a result of a lower survival rate, and hence higher indirect and intangible costs. Our estimates can be used to raise awareness of occupational solar UV exposure as an important causal factor in NMSCs and can highlight the importance of occupational BCC and SCC among other occupational cancers.     

Creating Smoke-Free Places Through the UN Convention on the Rights of Persons With Disabilities

In some high-, middle-, and low-income countries, law has been employed to limit individuals’ secondhand smoke exposure. Innovative legal tools are still needed, especially in low- and middle-income countries where smoking prevalence continues to rise.For some persons with severe respiratory conditions, the presence of secondhand smoke is intolerable and prevents their entrance into restaurants and other venues. With its adoption of the Convention on the Rights of Persons with Disabilities (CRPD) in 2006, the United Nations gave countries a new way to promote the rights of disabled individuals and simultaneously address secondhand smoke exposure.We analyze the CRPD’s potential to advance tobacco control goals and offer recommendations for advocates, policymakers, and others seeking to apply this approach.Tobacco use is one of the leading preventable causes of morbidity and mortality worldwide and is responsible for nearly 6 million deaths annually.1 Approximately 1.3 billion people smoke either cigarettes or bidis (the latter consisting of low-grade tobacco and used in South Asia),2 and about 80% of these smokers live in low- or middle-income countries (LMICs).3 Although the tobacco industry asserts that tobacco production is a source of economic growth—especially for LMICs—estimates suggest that when health costs are factored in, world tobacco production and use results in a net loss of $200 billion USD annually.4The health consequences of tobacco use are not limited to individuals who use tobacco; they are also experienced by nontobacco users, primarily through exposure to secondhand smoke. In 2004, secondhand smoke was responsible for approximately 600 000 deaths and approximately 10.9 million disability adjusted life years worldwide.5 During the same period, an estimated 40% of children, 33% of male nonsmokers, and 35% of female nonsmokers were exposed to secondhand smoke. Respiratory illnesses represent the largest disease burden from secondhand smoke, with approximately 6 million lower respiratory infections among children younger than 5 years, 1.2 million cases of asthma among adults, and 650 000 cases of asthma among children worldwide in 2004.5 For some individuals, particularly those with chronic, severe respiratory conditions, the presence of secondhand smoke is intolerable because it makes breathing exceptionally difficult.In both high-income countries and LMICs, the law has increasingly been used to limit individuals’ exposure to secondhand smoke. For at least the past 2 decades, governments throughout the world have employed legislation to establish smoke-free indoor environments, although challenges remain with the implementation, enforcement, and comprehensiveness of these laws.6 Although progress has been made, innovative legal tools to address secondhand smoke exposure are critical, especially in LMICs where smoking prevalence continues to rise.7The United Nations gave countries a new way to promote the rights of disabled individuals and simultaneously tackle secondhand smoke exposure with its adoption of the Convention on the Rights of Persons with Disabilities (CRPD) in 2006. The CRPD introduces protections for disabled persons—including those with severe respiratory conditions and accompanying intolerance to smoke exposure—into international law. Because it provides a legal foundation to argue that indoor smoking restrictions are a necessary accommodation for those with certain chronic respiratory conditions, the CRPD complements the goals of the World Health Organization’s (WHO’s) Framework Convention on Tobacco Control. We analyze the CRPD’s potential to advance tobacco control efforts, and offer recommendations for advocates, policymakers, and other stakeholders who seek to capitalize on this novel approach.     

A cost-effectiveness analysis of India's 2008 prohibition of smoking in public places in Gujarat

Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and premature mortality in low and middle-income countries. The aim of this study was to assess the cost-effectiveness of implementing India's Prohibition of Smoking in Public Places Rules in the state of Gujarat, compared to implementation of a complete smoking ban. Using standard cost-effectiveness analysis methods, the cost of implementing the alternatives was evaluated against the years of life saved and cases of acute myocardial infarction averted by reductions in smoking prevalence and secondhand smoke exposure. After one year, it is estimated that a complete smoking ban in Gujarat would avert 17,000 additional heart attacks and gain 438,000 life years (LY). A complete ban is highly cost-effective when key variables including legislation effectiveness were varied in the sensitivity analyses. Without including medical treatment costs averted, the cost-effectiveness ratio ranges from $2 to $112 per LY gained and $37 to $386 per acute myocardial infarction averted. Implementing a complete smoking ban would be a cost saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat.     

The annual impact of seasonal influenza in the US: measuring disease burden and costs

BACKGROUND: Despite preventive efforts, influenza epidemics are responsible for substantial morbidity and mortality every year in the United States (US). Vaccination strategies to reduce disease burden have been implemented. However, no previous studies have systematically estimated the annual economic burden of influenza epidemics, an estimate necessary to guide policy makers effectively. OBJECTIVE: We estimate age- and risk-specific disease burden, and medical and indirect costs attributable to annual influenza epidemics in the United States. METHODS: Using a probabilistic model and publicly available epidemiological data we estimated the number of influenza-attributable cases leading to outpatient visits, hospitalization, and mortality, as well as time lost from work absenteeism or premature death. With data from health insurance claims and projections of either earnings or statistical life values, we then estimated healthcare resource utilization associated with influenza cases as were their medical and productivity (indirect) costs in $2003. RESULTS: Based on 2003 US population, we estimated that annual influenza epidemics resulted in an average of 610,660 life-years lost (undiscounted), 3.1 million hospitalized days, and 31.4 million outpatient visits. Direct medical costs averaged $10.4 billion (95% confidence interval [C.I.], $4.1, $22.2) annually. Projected lost earnings due to illness and loss of life amounted to $16.3 billion (C.I., $8.7, $31.0) annually. The total economic burden of annual influenza epidemics using projected statistical life values amounted to $87.1 billion (C.I., $47.2, $149.5). CONCLUSIONS: These results highlight the enormous annual burden of influenza in the US. While hospitalization costs are important contributors, lost productivity from missed work days and lost lives comprise the bulk of the economic burden of influenza.     

What are the health costs of uranium mining? A case study of miners in Grants,New Mexico

Abstract

Background:

Uranium mining is associated with lung cancer and other health problems among miners. Health impacts are related with miner exposure to radon gas progeny.

Objectives:

This study estimates the health costs of excess lung cancer mortality among uranium miners in the largest uranium-producing district in the USA, centered in Grants, New Mexico.

Methods:

Lung cancer mortality rates on miners were used to estimate excess mortality and years of life lost (YLL) among the miner population in Grants from 1955 to 2005. A cost analysis was performed to estimate direct (medical) and indirect (premature mortality) health costs.

Results:

Total health costs ranged from $2·2 million to $7·7 million per excess death. This amounts to between $22·4 million and $165·8 million in annual health costs over the 1955–1990 mining period. Annual exposure-related lung cancer mortality was estimated at 2185·4 miners per 100?000, with a range of 1419·8–2974·3 per 100?000.

Conclusions:

Given renewed interest in uranium worldwide, results suggest a re-evaluation of radon exposure standards and inclusion of miner long-term health into mining planning decisions.     

Breast cancer: better care for less cost. Is it possible?

OBJECTIVES: To estimate the potential for cost reduction in the acute care setting and the required investment in the home care setting of implementing an outpatient/early discharge strategy for operable (stages I and II) breast cancer in Canada. METHODS: Data from a community hospital were augmented by expert knowledge and incorporated into the breast cancer submodel of Statistics Canada's Population Health Model. For the estimated 90% of patients for whom this approach was assumed to be appropriate, the resource utilization for outpatient breast-conserving surgery and 2 days of hospitalization for those women undergoing mastectomy was quantified and costed, as were the appropriate home care services. A 5% readmission rate for complications was assumed. Cost per case, total cost burden, investment in home care, savings in acute care, and net savings were calculated. Sensitivity analyses were performed around readmission rates and home care/surgical follow-up costs. All costs were determined in 1995 Canadian dollars. RESULTS: The cost of initial treatment for the 15,399 women diagnosed with stages I and II breast cancer in 1995 in Canada was estimated to be $127.6 million. Hospitalization made up 53% of these costs. Under the outpatient/early discharge strategy, the acute care cost of initial breast cancer management could be reduced by $47.2 million, with an investment in home care of $14.5 million ($453 per patient), resulting in an overall net saving of $33 million. Under this strategy, hospitalization would contribute only 21% to the total care cost. CONCLUSIONS: If Canadian surgeons and healthcare administrators were to work together to put in place processes to support ambulatory breast cancer surgery and if resources were redirected to the provision of home-based post-operative care, there would be potential for a large net healthcare saving and preservation of high-quality patient care.     

Health care costs of physical inactivity in Canadian adults

The purpose of this study was to provide a contemporary estimate of the health care cost of physical inactivity in Canadian adults. The health care cost was estimated using a prevalence-based approach. The estimated direct, indirect, and total health care costs of physical inactivity in Canada in 2009 were $2.4 billion, $4.3 billion, and $6.8 billion, respectively. These values represented 3.8%, 3.6%, and 3.7% of the overall health care costs.     

Cost effectiveness of rotavirus vaccination in Australia

OBJECTIVE: Rotavirus gastroenteritis causes substantial morbidity, including hospital admission, in young children. In the context of recent vaccine developments, this study aimed to estimate the cost-effectiveness of a rotavirus vaccination program in Australia. METHOD: Standard methods of health economic evaluation were used to assess the total cost of rotavirus immunisation (as the difference between estimated vaccination program costs and the cost of disease that would be avoided by immunisation) and relate this to the number of cases of disease that would be prevented. Estimates were made from both societal and health care systems perspectives. RESULTS: Based on Australian data on disease incidence and cost of hospitalisation, the current annual cost of rotavirus disease is about $26.0 million. Using conservative vaccine efficacy estimates, current immunization uptake rates and a cost of $30 per dose of vaccine, rotavirus immunisation would incur a net societal cost of $2.9 million ($11 per child), at a gross program cost of $21.6 million. These estimates are sensitive to two sources of uncertainty in the estimation of program delivery costs: vaccine price and whether separate immunization visits would be required. CONCLUSION: A rotavirus immunisation program would be cost-neutral to Australian society at a vaccine price of $26 per dose (or $19 when health care system costs only are considered). IMPLICATIONS: Rotavirus immunization may be cost-effective in Australia, but considerable uncertainty remains. Policy decisions will depend heavily on pricing of the vaccine and may also need to consider intangible costs not accounted for in this analysis.     

The mortality, morbidity, and economic costs of alcohol abuse in New Hampshire

Since alcoholism and alcohol abuse are the number one health problem in the United States, community-based estimates of mortality, morbidity, and economic costs associated with alcohol abuse are needed to convey their impact in local areas. In the state of New Hampshire, data were collected on alcohol consumption patterns, alcohol-associated mortality, years of potential life lost, hospital days associated with alcohol-related diagnoses, direct medical care costs, employment levels, and per capita incomes. Alcohol-attributable mortality and morbidity percentages were applied to these data to estimate the effects of alcohol abuse. In 1983, alcohol was associated with 4% of total statewide deaths. These included 37% of the deaths due to injury, 26% of the deaths due to digestive disease, and 3% of the deaths due to cancer. These deaths represented over 6,000 years of potential life lost. Between 4 and 7% of hospital days were attributable to alcohol-related diagnoses. Direct medical care costs attributable to alcohol were over $101 million; 10% of the direct medical costs in the state. Indirect costs (present value of lost earnings due to premature mortality and morbidity associated with alcohol) represented over $142 million. Property damage and insurance costs associated with alcohol were almost $13 million, and alcohol-related arrests added another $17 million. Excess absenteeism due to alcohol abuse cost another $33 million and lost productivity at work cost over $278 million. These economic costs totaled almost $600 million, or 5% of the gross state product. The methodology used to obtain these results is easily applied and is shown in the Appendix.     

The burden of fall-related injury among older persons in New South Wales

Objective: To develop a comprehensive estimate of the burden of fall‐related injury among older people in New South Wales. Methods: Fall injuries in 2006/07 were estimated using information from several datasets and the literature. Healthcare costs were calculated using Australia‐Refined – Diagnostic‐Related Group costs for hospital episodes of care and average costs for Emergency Department presentations, ambulance transport and residential aged care (RAC). Ratios of the cost of inpatient care relative to other health services, derived from the literature, were used to estimate the costs associated with these services. Results: In 2006/07, in NSW, there were almost 143,000 falls, among older people, resulting in injuries requiring medical treatment. The total cost of healthcare associated with these falls was estimated at $558.5 million. Although accounting for only 6% of the NSW population aged 65 years and older, persons in RAC accounted for 15% of the total cost of falls injury and 21% of hospital inpatient costs. Conclusion and implications: This study demonstrates the extremely high economic cost of falls in older persons and highlights the disproportionate impact of falls in RAC. The study underscores the urgent need for significant investment in fall‐injury prevention efforts in both the community and RAC settings.     

Lifetime Cost of Abusive Head Trauma at Ages 0–4, USA

This paper aims to estimate lifetime costs resulting from abusive head trauma (AHT) in the USA and the break-even effectiveness for prevention. A mathematical model incorporated data from Vital Statistics, the Healthcare Cost and Utilization Project Kids’ Inpatient Database, and previous studies. Unit costs were derived from published sources. From society’s perspective, discounted lifetime cost of an AHT averages $5.7 million (95% CI $3.2–9.2 million) for a death. It averages $2.6 million (95% CI $1.0–2.9 million) for a surviving AHT victim including $224,500 for medical care and related direct costs (2010 USD). The estimated 4824 incident AHT cases in 2010 had an estimated lifetime cost of $13.5 billion (95% CI $5.5–16.2 billion) including $257 million for medical care, $552 million for special education, $322 million for child protective services/criminal justice, $2.0 billion for lost work, and $10.3 billion for lost quality of life. Government sources paid an estimated $1.3 billion. Out-of-pocket benefits of existing prevention programming would exceed its costs if it prevents 2% of cases. When a child survives AHT, providers and caregivers can anticipate a lifetime of potentially costly and life-threatening care needs. Better effectiveness estimates are needed for both broad prevention messaging and intensive prevention targeting high-risk caregivers.     

Maternal smoking and medical expenditures for childhood respiratory illness.

OBJECTIVES: This study sought to assess the association between environmental tobacco smoke exposure from maternal smoking and health care expenditures for respiratory conditions among US children. METHODS: Multivariate analysis of the 1987 National Medical Expenditure Survey was undertaken with a sample that included 2624 children 5 years of age and under. RESULTS: After analysis that controlled for various sociodemographic factors associated with health care usage, respiratory-related health care expenditures among children whose mothers smoke were found to be significantly higher than those expenditures for children of nonsmoking mothers. Truncated regression techniques were used to estimate that maternal smoking was associated with increased health care expenditures averaging (in 1995 dollars) $120 per year for children aged 5 years and under and $175 per year for children aged 2 years and under. Our analysis indicates that passive smoking was associated with $661 million in annual medical expenditures in 1987, representing 19% of all expenditures for childhood respiratory conditions. CONCLUSIONS: Maternal smoking is associated with significantly increased child health expenditures and contributes significantly to the overall cost of medical care.     

What are the health costs of uranium mining? A case study of miners in Grants,New Mexico

Background:

Uranium mining is associated with lung cancer and other health problems among miners. Health impacts are related with miner exposure to radon gas progeny.

Objectives:

This study estimates the health costs of excess lung cancer mortality among uranium miners in the largest uranium-producing district in the USA, centered in Grants, New Mexico.

Methods:

Lung cancer mortality rates on miners were used to estimate excess mortality and years of life lost (YLL) among the miner population in Grants from 1955 to 2005. A cost analysis was performed to estimate direct (medical) and indirect (premature mortality) health costs.

Results:

Total health costs ranged from $2.2 million to $7.7 million per excess death. This amounts to between $22.4 million and $165.8 million in annual health costs over the 1955–1990 mining period. Annual exposure-related lung cancer mortality was estimated at 2185.4 miners per 100 000, with a range of 1419.8–2974.3 per 100 000.

Conclusions:

Given renewed interest in uranium worldwide, results suggest a re-evaluation of radon exposure standards and inclusion of miner long-term health into mining planning decisions.     

Secondhand smoke exposure in the workplace

BACKGROUND: Currently, there is little understanding of the relationship between the strength of workplace smoking policies and the likelihood and duration, not just the likelihood, of exposure to secondhand smoke at work. METHODS: This study assessed self-reported exposure to secondhand smoke at work in hours per week among a cross-sectional sample of 3650 Massachusetts adults who were employed primarily at a single worksite outside the home that was not mainly outdoors. The sample data were from a larger longitudinal study designed to examine the effect of community-based tobacco control interventions on adult and youth smoking behavior. Participants were identified through a random-digit-dialing telephone survey. Multiple logistic regression and zero-inflated negative binomial regression models were used to estimate the independent effect of workplace smoking policies on the likelihood and duration of exposure to secondhand smoke. RESULTS: Compared to employees whose workplace banned smoking completely, those whose workplace provided designated smoking areas had 2.9 times the odds of being exposed to secondhand smoke and 1.74 times the duration of exposure, while those with no restrictions had 10.27 times the odds of being exposed and 6.34 times the duration of exposure. CONCLUSIONS: Workplace smoking policies substantially reduce the likelihood of self-reported secondhand smoke exposure among employees in the workplace and also greatly affect the duration of exposure.