Annual smoking-attributable mortality, years of potential life lost, and productivity losses--United States, 1997-2001

Smoking harms nearly every organ of the body, causing many diseases and reducing quality of life and life expectancy. This report assesses the health consequences and productivity losses attributable to smoking in the United States during 1997-2001. CDC calculated national estimates of annual smoking-attributable mortality (SAM), years of potential life lost (YPLL) for adults and infants, and productivity losses for adults. The findings indicated that, during 1997-2001, cigarette smoking and exposure to tobacco smoke resulted in approximately 438,000 premature deaths in the United States, 5.5 million YPLL, and 92 billion dollars in productivity losses annually. Implementation of comprehensive tobacco-control programs as recommended by CDC can reduce smoking prevalence and related mortality and health-care costs.     

Cigarette smoking-attributable morbidity---United States, 2000

Each year in the United States, approximately 440,000 persons die of a cigarette smoking-attributable illness, resulting in 5.6 million years of potential life lost, $75 billion in direct medical costs, and $82 billion in lost productivity. To assess smoking-attributable morbidity, the Roswell Park Cancer Institute, Research Triangle Institute, and CDC analyzed data from three sources: the Behavioral Risk Factor Surveillance System (BRFSS), the National Health and Nutrition Examination Survey III (NHANES III), and the U.S. Census. This report summarizes the results of that analysis, which indicate that an estimated 8.6 million persons in the United States have serious illnesses attributed to smoking; chronic bronchitis and emphysema account for 59% of all smoking-attributable diseases. These findings underscore the need to expand surveillance of the disease burden caused by smoking and to establish comprehensive tobacco-use prevention and cessation efforts to reduce the adverse health impact of smoking.     

The Health and Economic Consequences of Cigarette Smoking in Alabama, 2009–2010

While CDC reports on the health and economic burden of smoking in the United States, state-specific data are not readily available. We estimated the health and economic consequences of cigarette smoking in Alabama to provide the state legislature with the state-specific data that reveal the direct impact of smoking on their constituents. We estimated that in 2009, almost 7,900 adult deaths (18% of all adult deaths) and approximately 121,000 years of potential life lost among Alabama adults aged 35 years and older were attributable to cigarette smoking. Productivity losses due to premature death and smoking-attributable illness were estimated at $2.84 billion and $941 million, respectively. Our findings support a strong need for tobacco control and prevention programs to decrease the health and economic burden of smoking in Alabama. These results are being used by the State Health Officer to illustrate the real costs of smoking in Alabama and to advocate for improved tobacco control policies.Tobacco use is one of the most preventable causes of disease and death in the United States.¹ Cigarette smoking drastically increases the risk of disease and is associated with medical conditions that cause death, including cancer, cardiovascular disease, respiratory disease, and perinatal conditions. In the U.S., smoking accounts for approximately 443,000 deaths each year.² While the U.S. Centers for Disease Control and Prevention (CDC) and other health organizations report on the burden of cigarette smoking nationwide, state-specific data are not as readily available. Yet, providing state-specific information can have a greater impact on state policy makers than national data because it reveals the direct impact of smoking on a state''s constituents.To understand the current health and economic consequences of cigarette use in Alabama, in 2011, the Alabama Department of Public Health (ADPH) and the Institute for Social Science Research at the University of Alabama produced estimates of smoking-attributable mortality (SAM), years of potential life lost (YPLL), and productivity losses using CDC''s Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) calculator.³ The resulting estimates are being used by the State Health Officer to illustrate the real costs of smoking in Alabama to policy makers and the public. This study can be used as a model for how researchers can estimate the burden of cigarette smoking in other states.     

State-specific prevalence of current cigarette smoking among adults--United States, 2002

Cigarette smoking in the United States causes serious illnesses among an estimated 8.6 million persons and approximately 440,000 deaths annually, resulting in 157 billion dollars in health-related economic costs. To reduce smoking prevalence, morbidity, mortality, and economic impact, state tobacco-control programs should include interventions to help persons stop smoking. To assess the prevalence of current cigarette smoking among adults, attempts to quit, and receipt of physician advice to quit during the preceding year, CDC analyzed data from the 2002 Behavioral Risk Factor Surveillance System (BRFSS) survey. This report summarizes the results of that analysis, which indicated a threefold difference in smoking prevalence across the 50 states, the District of Columbia (DC), Guam, Puerto Rico, and the U.S. Virgin Islands (range: 9.5%-32.6%). To support smokers' attempts to quit, states/areas should implement comprehensive tobacco-control programs that include interventions to help persons stop smoking (e.g., quitlines).     

Racial disparities in smoking-attributable mortality and years of potential life lost --- Missouri, 2003-2007

An estimated 443,000 deaths in the United States occur each year as a result of cigarette smoking and exposure to secondhand smoke. These deaths cost the nation approximately $97 billion in lost productivity and $96 billion in health-care costs. During 2000-2004 in Missouri, smoking caused 9,600 deaths, 132,000 years of potential life lost (YPLL), $2.4 billion in productivity losses, and $2.2 billion in smoking-related health-care expenditures annually. To limit the adverse health consequences of tobacco use, states implement comprehensive tobacco control programs that identify disparities among population groups and target those disproportionately affected by tobacco use. This report compares the public health burden of smoking among whites and blacks in Missouri by estimating the number of smoking-attributable deaths and YPLL in these population subgroups during 2003-2007. The findings indicate that the average annual smoking-attributable mortality (SAM) rate in the state was 18% higher for blacks (338 deaths per 100,000) than for whites (286 deaths per 100,000). The relative difference in smoking-attributable mortality rates between blacks and whites was larger for men (28%) than women (11%). For Missouri, these estimates provide an important benchmark for measuring the success of tobacco control programs in decreasing the burden of smoking-related diseases in these populations and reaffirm the need for full implementation of the state's comprehensive tobacco control program.     

Impact of smoking in Italy in 1998: deaths and years of potential life lost

This report presents the impact of smoking habits on Italian mortality in 1998. Estimates of smoking-attributable fraction (FAF), smoking-attributable mortality (MAF), and years of potential life lost (YPLLf) were calculated using the SAMMEC software (CDC, USA), and the Peto method. During 1998, using the SAMMEC software, smoking caused approximately 83,650 premature deaths in Italy (67,600 in men, 16,000 in women, and 45 in infants), equal to 15.1% of mortality in adults above the age of 35 years (24.4% of mortality in men and 5.8% in women). YPLLf were about 900,000 in men, 221,000 in women, and 3,500 in infants. Using the Peto method, smoking-attributable deaths were about 70,200 (59,600 in men and 10,600 in women), equal to 12.7% of mortality in adults older than 35 years (21.5% of mortality in men and 3.9% in women). YPLLf were about 806,000 in men and 142,000 in women. Among adults, for both methods most smoking-related deaths were attributable to lung cancer, ischemic heart disease, chronic airways obstruction, and cerebrovascular disease. Differences between the estimates of the two methods underline the gap between a more conservative estimate (Peto method) and a less restrictive one (SAMMEC software). Given validity for both methods, it is likely smoking habits caused between 70,000 and 83,000 deaths in Italy during 1998.     

Update: direct and indirect costs of arthritis and other rheumatic conditions--United States, 1997

The medical and societal impact of arthritis and other rheumatic conditions (AORC) has been characterized with respect to disability, ambulatory care, hospitalization, and economic burden. CDC's estimates of the national and state-specific costs of AORC in the United States in 1997 have been published previously. However, CDC has re-estimated indirect costs by enhancing the statistical methods. This report summarizes the results of that analysis, which indicated that indirect costs were 30.1 billion dollars less than previously estimated. The total cost of AORC in the United States in 1997 was 86.2 billion dollars (including 51.1 billion dollars in direct costs and 35.1 billion dollars in indirect costs), approximately 1% of the U.S. gross domestic product. Total costs attributable to AORC by state ranged from 121 million dollars in Wyoming to 8.4 billion dollars in California. Although indirect costs were lower than estimated previously, costs for arthritis remain high and underscore the need for better interventions to reduce the economic burden of arthritis.     

Mental illness surveillance among adults in the United States

Mental illnesses account for a larger proportion of disability in developed countries than any other group of illnesses, including cancer and heart disease. In 2004, an estimated 25% of adults in the United States reported having a mental illness in the previous year. The economic cost of mental illness in the United States is substantial, approximately $300 billion in 2002. Population surveys and surveys of health-care use measure the occurrence of mental illness, associated risk behaviors (e.g., alcohol and drug abuse) and chronic conditions, and use of mental health-related care and clinical services. Population-based surveys and surveillance systems provide much of the evidence needed to guide effective mental health promotion, mental illness prevention, and treatment programs. This report summarizes data from selected CDC surveillance systems that measure the prevalence and impact of mental illness in the U.S. adult population. CDC surveillance systems provide several types of mental health information: estimates of the prevalence of diagnosed mental illness from self-report or recorded diagnosis, estimates of the prevalence of symptoms associated with mental illness, and estimates of the impact of mental illness on health and well-being. Data from the CDC 2005-2008 National Health and Nutrition Examination Survey indicate that 6.8% of adults had moderate to severe depression in the 2 weeks before completing the survey. State-specific data from the CDC 2006 Behavioral Risk Factor Surveillance System (BRFSS), the most recent BRFSS data available, indicate that the prevalence of moderate to severe depression was generally higher in southeastern states compared with other states. Two other CDC surveys on ambulatory care services, the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, indicate that during 2007-2008, approximately 5% of ambulatory care visits involved patients with a diagnosis of a mental health disorder, and most of these were classified as depression, psychoses, or anxiety disorders. Future surveillance should pay particular attention to changes in the prevalence of depression both nationwide and at the state and county levels. In addition, national and state-level mental illness surveillance should measure a wider range of psychiatric conditions and should include anxiety disorders. Many mental illnesses can be managed successfully, and increasing access to and use of mental health treatment services could substantially reduce the associated morbidity.     

Prevention of smoking-related deaths in the United States

BACKGROUND: Tobacco is the leading cause of death in the United States. The majority of people who smoke begin before age 18. OBJECTIVE: Determine the number of smoking-attributable deaths and years of potential life lost (YPLL) in adults that might be saved through interventions to reduce smoking prevalence among children and adolescents. METHODS: Calculation of the smoking-attributable mortality and years of potential life lost by age 85 among the cohort of people aged 18 in 2000. RESULTS: By age 85, there would be 127,670 smoking-attributable deaths among women and 284,502 deaths among men, for a total 412,172 smoking-attributable deaths in the United States among the cohort of 3,964,704 people aged 18 years alive in 2000. Through large-scale multimedia campaigns and a $1 increase in the price per pack of cigarettes, smoking prevalence could be reduced by 26% and would result in an annual savings of 108,466 lives and 1.6 million YPLL. CONCLUSIONS: Interventions to decrease smoking prevalence among children and adolescents can have large effects on adult mortality.     

Cigarette smoking among adults--United States, 2006

One of the national health objectives for 2010 is to reduce the prevalence of cigarette smoking among adults to > or =12% (objective 7-1a). To assess progress toward achieving this objective, CDC analyzed data from the 2006 National Health Interview Survey (NHIS). This report summarizes the results of that analysis, which indicated that in 2006, approximately 20.8% of U.S. adults were current cigarette smokers. This prevalence had not changed significantly since 2004, suggesting a stall in the previous 7-year (1997-2004) decline in cigarette smoking among adults in the United States. In addition, the findings indicated that persons with a diagnosis of a smoking-related chronic disease have a significantly higher prevalence of being a current smoker than persons with other chronic diseases or persons with no chronic disease. To reduce smoking prevalence further in the United States, comprehensive, evidence-based approaches for preventing smoking initiation and increasing cessation, including clinical interventions for populations at high risk, need to be fully implemented.     

Cigarette smoking among adults--United States, 2001

One of the national health objectives for the United States for 2010 is to reduce the prevalence of cigarette smoking among adults to > or =12% (objective 27.1a). To assess progress toward this objective, CDC analyzed self-reported data from the 2001 National Health Interview Survey (NHIS). The findings of this analysis indicate that, in 2001, approximately 22.8% of U.S. adults were current smokers compared with 25.0% in 1993. During 1965-2001, smoking prevalence declined faster among non-Hispanic blacks aged > or =18 years than among non-Hispanic whites the same age. Preliminary data for January-March 2002 indicate a continuing decline in current smoking prevalence among adults overall. However, the overall decline in smoking is not occurring at a rate that will meet the national health objective by 2010. Increased emphasis on a comprehensive approach to cessation that comprises educational, economic, clinical, and regulatory strategies is required to further reduce the prevalence of smoking in the United States.     

Cigarette smoking among adults--United States, 1997

In the United States, cigarette smoking is the leading cause of preventable morbidity and mortality and results in approximately 430,000 deaths each year (1). One of the national health objectives for 2000 is to reduce the prevalence of cigarette smoking among adults to no more than 15% (objective 3.4) (2). To assess progress toward meeting this objective, CDC analyzed self-reported data about cigarette smoking among U.S. adults from the 1997 National Health Interview Survey (NHIS) Sample Adult Core Questionnaire. This report summarizes the findings of this analysis, which indicate that, in 1997, 24.7% of adults were current smokers and that the overall prevalence of current smoking in 1997 was unchanged from the overall prevalence of current smoking from the 1995 NHIS.     

State estimates of neonatal health-care costs associated with maternal smoking--United States, 1996

Smoking during pregnancy can cause poor outcomes for both the pregnant woman and her unborn child and also result in added health-care expenditures. To characterize costs by state, CDC analyzed pregnancy risk surveillance and birth certificate data to estimate the association between maternal smoking and the probability of infant admission to a neonatal intensive care unit (NICU). Neonatal health-care costs, in 1996 dollars, were assigned on the basis of data from private health insurance claims. This report summarizes the results of that analysis, which estimated smoking-attributable neonatal expenditures (SAEs) of 366 million dollars in the United States in 1996, or 704 dollars per maternal smoker, and indicated wide variations in SAEs among states. These costs are preventable. States can use these data to justify or support their prevention and cessation treatment strategies.     

Costs of smoking among active duty U.S. Air Force personnel--United States, 1997

Smoking is the leading cause of preventable disease and death in the United States (1). The health consequences of smoking impose a substantial economic toll on persons, employers, and society. Smoking accounts for $50-$73 billion in annual medical-care expenditures, or 6%-12% of all U.S. medical costs (2-5). The costs associated with lost productivity also are extensive (2). In 1997, approximately 25% of male and 27% of female active duty Air Force (ADAF) personnel aged 17-64 years were smokers (6). A 1997 retrospective cohort study was conducted among ADAF personnel to estimate the short-term medical and lost productivity costs of current smoking to the U.S. Air Force (USAF). This report summarizes the results of the study, which indicate that current smoking costs the USAF approximately $107.2 million per year: $20 million from medical-care expenditures and $87 million from lost workdays.     

Decline in annual incidence of varicella--selected states, 1990-2001

Varicella (chickenpox) is a common, highly infectious, and vaccine-preventable disease. Before the introduction of the live attenuated varicella vaccine in 1995, approximately 4 million cases of varicella occurred annually in the United States, resulting in approximately 11,000 hospitalizations and 100 deaths. In 1996, the Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination of all children at age 12-18 months, catch-up vaccination of all susceptible children before age 13 years, and vaccination of susceptible persons with close contact to persons at high risk for serious complications. In 1999, ACIP updated these recommendations to include vaccination requirements for child care and school entry and for postexposure; ACIP also strengthened recommendations for vaccination of susceptible adults and indicated that varicella vaccine should be considered for outbreak control. Changes in the national annual reported incidence of varicella disease during 1972-1997 have been reported previously. This report summarizes trends in the annual reported incidence of varicella disease in selected states during 1990-2001. The findings underscore the continued need to improve varicella surveillance to monitor the impact of the varicella vaccination program and assess any changes in varicella transmission and disease.     

Mortality and Economic Costs From Regular Cigar Use in the United States, 2010

Objectives. We estimated annual mortality, years of potential life lost, and associated economic costs attributable to regular cigar smoking among US adults aged 35 years or older.Methods. We estimated cigar-attributable mortality for the United States in 2010 using the Centers for Disease Control and Prevention’s Smoking-Attributable Mortality, Morbidity, and Economic Costs methodology for smoking-related causes of death. We obtained cigar prevalence from the National Adult Tobacco Survey, relative risks from the Cancer Prevention Studies I and II, and annual US deaths from the National Vital Statistics System. We also estimated the economic cost of this premature mortality using the value of a statistical life-year.Results. Regular cigar smoking was responsible for approximately 9000 premature deaths and more than 140 000 years of potential life lost among US adults aged 35 years or older in 2010. These years of life had an economic value of approximately $23 billion.Conclusions. The health and economic burden of cigar smoking in the United States is large and may increase over time because of the increasing consumption of cigars in the United States.Cigar use and its accompanying health risks are a significant and growing public health problem in the United States. From 2000 to 2011, consumption of cigars more than doubled in the United States, from slightly less than 6.2 billion in 2000 to more than 13.7 billion in 2011.1 By contrast, cigarette consumption decreased by 33%, from 435.6 billion to 292.8 billion during this period.The cigar category includes a variety of products, including little cigars, cigarillos, and large cigars. Small cigars such as little cigars and cigarillos are sold in a variety of packages and sizes, some of which resemble cigarettes.2 Many small cigars also contain characterizing flavors, such as fruit, chocolate, and alcohol,3 and are taxed at a lower rate than are cigarettes, which can increase their appeal to young people. Within the cigar category, some products are experiencing faster growth in use than are others. According to the Centers for Disease Control and Prevention (CDC),1 consumption of small cigars increased almost 240% between 2003 and 2008, from 2.47 billion to 5.88 billion units. Sales of large cigars increased by 25% during this period, from 4.53 billion to 5.66 billion units.Cigar use is most common among young people. The CDC, on the basis of National Youth Tobacco Survey data, estimated that 12.6% of US high school students in 2012 had smoked a cigar in the past 30 days.4 Among high school males, an estimated 16.7% had smoked a cigar in the past 30 days compared with 16.3% who had smoked cigarettes during this period. Cigars were also found to be the most commonly used tobacco product among African American high school students. Results from CDC’s National Adult Tobacco Survey (NATS) for 2009–20105 showed that cigar smoking prevalence among adults was highest among those aged 18 to 24 years (15.9%) and 25 to 44 years (7.2%).Cigars pose significant health risks to users. Cigar smoke contains many of the same toxic and carcinogenic compounds as does cigarette smoke and may have higher concentrations of some constituents, such as nitrogen oxide, ammonia, and tobacco-specific nitrosamines.6 Research has found that cigar smoking increases the risk of dying from causes such as cardiovascular disease, lung cancer, and oral cancer.7,8 In general, differences in risk between cigarettes and cigars are driven primarily by differences in smoking behavior such as frequency of use and depth of inhalation.The risks of upper aerodigestive tract cancers such as oral and esophageal cancer are particularly elevated for cigar smokers and comparable to risks for cigarette smokers.7,8 The CDC has previously used its Smoking-Attributable Mortality, Morbidity, and Economic Costs methodology to estimate that cigarette smoking is responsible for approximately 480 000 deaths in the United States each year.9,10 Similar estimates, however, are currently unavailable for cigar smoking.We employed an approach similar to the Smoking-Attributable Mortality, Morbidity, and Economic Costs methodology to quantify the population health burden of regular cigar smoking in the United States. In doing so, we have presented for the first time, to our knowledge, estimates of the overall mortality and economic costs owing to regular cigar smoking for the US population.     

Health-related quality of life among persons with epilepsy--Texas, 1998

Epilepsy is a central nervous system disorder characterized by unprovoked, recurrent seizures that may affect physical, mental, or behavioral functioning. In 1995, approximately 2.3 million persons residing in the United States had epilepsy. Approximately 181,000 new cases of epilepsy are diagnosed each year, with annual estimated costs of $12.5 billion in medical care and lost productivity. Because epilepsy has a substantial impact on health (e.g., physical and psychosocial difficulties, side effects of anticonvulsant therapy, lifestyle restrictions, and perceived stigmatization), self-reported physical and mental health-related quality of life (HRQOL) measures are useful in gauging the impact of epilepsy on persons with the disorder. Persons with chronic health disorders are at risk for impaired HRQOL. Few studies have examined the HRQOL of persons with epilepsy, and none has used a representative sample of adults residing in the United States. This report examines data from the 1998 Texas Behavioral Risk Factor Surveillance System (BRFSS) that included a question about epilepsy; findings indicate that persons with epilepsy reported substantially worse HRQOL than persons without epilepsy. Community-based interventions such as the Sepulveda Epilepsy Education Program that address medication self-management, psychosocial self-management, and other education interventions can improve the quality of life for persons with epilepsy.     

Lung cancer rates as an index of tobacco smoke exposures: validation against black male approximate non-lung cancer death rates, 1969-2000

BACKGROUND: Researchers use lung cancer death rates (rates) as an index of the cumulative burdens of smoking. That index lacks direct validation and calibration. So this study directly validates and calibrates that index against annual approximately non-lung (all-sites minus lung and stomach) rates from 1969 to 2000 in United States black men, then estimates their cancer death rate smoking-attributable fractions (SAFs). METHODS: This study uses linear regression, age-adjusted rates from http://www.seer.cancer.gov/canques, and the formula SAF = (1- ((rate in the unexposed) / (rate in the exposed))). Estimated rates in the unexposed range between the 1969 rate and the rate predicted for a population with no smoking-attributable lung cancers. Stomach and lung cancer rate SAFs were based on published cohort studies. RESULTS: Lung cancer death rates predicted 98% and 97% of the variances in approximately non-lung cancer death rates throughout their 1969-1990 34% rise and subsequent declines, respectively (each P < 0.0001). The findings suggest that the SAF of the all-sites cancer death rate in black men peaked at 66% in 1990. CONCLUSIONS: Lung cancer death rates were a good index of smoke exposure for predicting approximately non-lung cancer death rates in black men. Smoking may cause most premature cancer deaths in black men.     

Prevalence of disabilities and associated health conditions among adults--United States, 1999

In the United States, the number of persons reporting disabling conditions increased from 49 million during 1991-1992 to 54 million during 1994-1995. During 1996, direct medical costs for persons with disability were $260 billion. Surveillance of disability prevalence and associated health conditions is useful in setting policy, anticipating the service needs of health systems, assisting state programs, directing health promotion and disease prevention efforts, and monitoring national health objectives. The U.S. Bureau of the Census and CDC analyzed data from the Survey of Income and Program Participation (SIPP) to determine national prevalence estimates of adults with disabilities and associated health conditions. This report summarizes findings of that analysis, which indicate that disability continues to be an important public health problem, even among working adults, and arthritis or rheumatism, back or spine problems, and heart trouble/hardening of the arteries remain the leading causes. Better health promotion and disease prevention may reduce the prevalence of disability-associated health conditions.