The morbidity,mortality, and economic costs of cigarette smoking in New Hampshire

The Surgeon General of the United States Public Health Service has identified cigarette smoking as the single most important source of preventable morbidity and premature mortality. An analysis was conducted in the state of New Hampshire to determine the consequences of smoking: morbidity, mortality, and economic costs to the population. Data were collected on smoking prevalence, smoking attributed deaths, years of potential life lost, hospital days attributed to smoking diagnoses, direct medical costs, and per capita incomes. Smoking attributable fractions were applied to these data. In 1983, 16% of total statewide deaths were attributable to cigarette smoking. These deaths included 15% of the cardiovascular deaths, 20% of cancer deaths, 42% of respiratory disease deaths, 3% of digestive disease deaths, and 5% of infant deaths, in a population of less than 1 million. These deaths represented almost 3100 years of potential life lost. Smoking attributable hospital days totaled almost 70,000, for 8% of male and 4% of female hospital days. Direct medical care costs attributable to cigarette smoking were over $76 million, 7% of the total statewide medical costs. Indirect costs (present value of lost earnings due to premature mortality and morbidity attributable to smoking) were almost $118 million. These economic costs totaled almost $200 million. The results of this study were used extensively by the New Hampshire media and volunteer agencies. This methodology can be a model for other local area analyses.Robin D. Gorsky, Ph.D. is an Assistant Professor in the Department of Health Management and Policy, University of New Hampshire, Durham, NH 03824. Eugene Schwartz, M.D., M.P.H. is Epidemiologist and Director of the Bureau of Cancer Control, Washington, DC. David Dennis, M.D., M.P.H., is the Director of the Bureau of Disease Control, Commonwealth of Pennsylvania, and in the Division of Field Services, Epidemiology Program Office, Centers for Disease Control, Atlanta, GA. This study was completed at and supported in part by the Bureau of Disease Control, Division of Public Health Services, Department of Health and Human Services, Concord, NH, and the Department of Health Management and Policy, University of New Hampshire, Durham, NH. Requests for reprints should be addressed to: Robin D. Gorsky, Ph.D., Department of Health Management and Policy, University of New Hampshire, Durham, NH 03824.