Avoidable Portion of Tobacco-Attributable Acute Care Hospital Days and Its Cost Due to Implementation of Different Intervention Strategies in Canada
Abstract
:1. Introduction
2. Methodology
2.1. Selection of Interventions
2.2. Methodological Considerations for Statistical Modeling
- → Estimation of population disease with sex and age specific population-attributable fractions, in the case of tobacco with smoking-attributable fractions (SAF).
- → Based on SAF, tobacco-attributable morbidity expressed in the number of acute care hospital days.
2.3. Computing Smoking-Attributable Fractions
RR(x) | relative risk at exposure level x |
P(x) | population distribution of exposure |
P′(x) | counterfactual distribution of exposure (often 0 = no exposure for tobacco) |
m | maximum exposure level |
2.4. Smoking Risk Relations
2.5. Prevalence of Smoking in Canada
- Yearly quitting rates of 10%;
- The assumption that 80% of smokers wanted to quit;
- The assumption of an annual incidence rate (new cases of smokers before and after intervention in the specified year) of 0.46% for current female non-smokers, and prevalence proportionate incidence rate for males.
2.6. Morbidity Data
2.7. Estimating Avoidable Morbidity and Its Cost
3. Results
3.1. Collection of Evidence for Most Common Interventions
a) Public policy interventions:
1) Price increase
b) Interventions focusing on individual behavioural change (counselling, brief advice, therapy):
2) Individual behavioural counselling (IBC) for smoking cessation
3) Nicotine replacement therapy (NRT) for smoking cessation
4) Physician advice for smoking cessation
3.2. Exposure
3.3. Tobacco-Attributable Morbidity in Canada 2002
3.4. Effectiveness of Interventions
3.5. Avoidable Morbidity and Its Cost in Canada
3.6. Limitations and Conclusion of the Study
Acknowledgments
References
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Cause of morbidity | ICD 9 | ICD10 | RRs (Source: [25]) | Comments | |
---|---|---|---|---|---|
FS | CS | ||||
Lip, oral and pharyngeal cancer | 140–149 | C00–C14 | 1.76 | 4.55 | RRs for codes: 140–141, 143–149 |
Esophageal cancer | 150 | C15 | 1.79 | 4.01 | |
Stomach cancer | 151 | C16 | 1.11 | 1.41 | |
Liver cancer | 155 | C22 | 1.07 | 1.71 | |
Pancreatic cancer | 157 | C25 | 1.15 | 1.86 | |
Laryngeal cancer | 161 | C32 | 2.86 | 7.48 | |
Lung cancer – m | 162 | C33–C34 | 6.75 | 13.0 | |
Lung cancer – w | - | - | 5.07 | 11.4 | |
Cervical cancer | 180 | C53 | 1.31 | 1.75 | RRs for codes: 180, 233.1 |
Bladder cancer | 188 | C67 | 1.66 | 2.72 | |
Kidney, other urinary cancer | 189 | C64–C66, C68 | 1.61 | 1.64 | Renal parenchymal carcinoma −189.0 |
Leukemia | 204–208 | C91–C95 | 1.21 | 1.01 | |
Parkinson disease | 332 | G20–G21 | 0.57 | 0.57 | |
Ischaemic heart disease <65 | 410–414 | I20–I25 | 1.45 | 3.06 | |
Ischaemic heart disease -m 65+ | - | - | 0.93 | 1.67 | |
Ischaemic heart disease -w 65+ | - | - | 1.22 | 1.67 | |
Other heart diseases | 390–398, 415–417, 420–429 | I00–I09, I26–I51 | NA | NA | |
Cerebrovascular disease <65 | 430–438 | I60–I69 | 1.30 | 3.12 | |
Cerebrovascular disease 65+ | - | - | 1.15 | 1.65 | |
Atherosclerosis | 440 | I70 | NA | NA | |
Other arterial diseases | 441–448 | I71–I78 | NA | NA | |
Atherosclerosis and other arterial diseases | 440–448 | I70–I78 | 1.82 | 2.54 | |
Pneumonia | 480–487 | J10–J18 | 1.29 | 1.47 | |
Bronchitis, emphysema | 490–492 | J40–J43 | NA | NA | |
Chronic airways obstruction | 496 | J44 | NA | NA | |
COPD | 490–492, 496 | J40–J44 | 6.70 | 9.80 | |
Peptic ulcer | 531–534 | K25–K27 | 2.24 | 2.07 | |
Crohn disease – m | 555 | K50 | 1.92 | 1.92 | |
Crohn disease – w | - | - | 1.60 | 3.27 | |
Ulcerative colitis | 556 | K51 | 1.71 | 0.63 | |
Fire injury | E890–E899 | X00–X09 | NA | NA | TAF = 23% |
Provinces | Average cost per night $ |
---|---|
Alberta | 1,311 |
British Columbia | 1,524 |
Manitoba | 1,346 |
New Brunswick | 1,284 |
Newfoundland | 1,455 |
Nova Scotia | 1,217 |
Ontario | 1,045 |
Prince Edward Island | 798 |
Quebec | 990 |
Saskatchewan | 1,263 |
Northwest Territory | 2,177 |
Nunavut | SUB |
Yukon Territory | 883 |
CANADA | 1,109 |
Type of intervention | Effect | Reference |
---|---|---|
Public policy interventions | ||
Taxation and price increases | 2% prevalence reduction in smokers associated with 10% increase in price, based on meta-analysis for high income countries. | [30] |
Interventions focusing on individual behavioural change | ||
Individual behavioural counselling for smoking cessation (non-medical)
Nicotine replacement therapy for smoking cessation Physician advice for smoking cessation | Cessation ratio of 1.56 (95% CI: 1.32–1.84) compared to controls without intervention
Cessation ratio of 1.58 (95% CI: 1.50–1.66) compared to controls without intervention Cessation ratio of 1.66 (95% CI: 1.42–1.94) compared to controls without intervention | [31]
[32] [33] |
Overall (all ages >15) | 15–19 Yrs | 20–44 Yrs | 45–64 Yrs | 65+ Yrs | ||||||
---|---|---|---|---|---|---|---|---|---|---|
M% | W% | M% | W% | M% | W% | M% | W% | M% | W% | |
Natural course plus quitters plus new beginners = baseline scenario | ||||||||||
NS | 29.1 | 40.4 | 58.3 | 59.2 | 32.4 | 38.7 | 20.8 | 34.2 | 18.8 | 47.6 |
FS | 44.6 | 37.8 | 20.0 | 18.6 | 35.1 | 35.3 | 54.7 | 44.1 | 69.7 | 41.9 |
CS | 26.3 | 21.8 | 21.8 | 22.2 | 32.5 | 26.0 | 24.5 | 21.7 | 11.5 | 10.5 |
100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | |
Taxation change to result in price increases of 10% | ||||||||||
FS | 45.1 | 38.2 | 20.4 | 19.0 | 35.8 | 35.8 | 55.2 | 44.5 | 69.8 | 42.2 |
CS | 25.8 | 21.4 | 21.3 | 21.7 | 31.8 | 25.5 | 24.0 | 21.3 | 11.4 | 10.2 |
100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | |||
Individual behavioural counselling (assuming 40% coverage based on those willing to quit) | ||||||||||
FS | 45.2 | 38.3 | 20.5 | 19.0 | 35.9 | 35.9 | 55.3 | 44.6 | 69.9 | 42.2 |
CS | 25.7 | 21.3 | 21.3 | 21.7 | 31.7 | 25.4 | 23.9 | 21.1 | 11.3 | 10.2 |
100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | |||
NRT (assuming 40% coverage based on those willing to quit) | ||||||||||
FS | 45.4 | 38.5 | 20.6 | 19.3 | 36.2 | 36.1 | 55.5 | 44.9 | 70.0 | 42.4 |
CS | 25.4 | 21.1 | 21.1 | 21.5 | 31.4 | 25.2 | 23.7 | 20.9 | 11.2 | 10.1 |
100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | |||
Physician’s advice (assuming 40% coverage based on those willing to quit) | ||||||||||
FS | 45.4 | 38.5 | 20.6 | 19.2 | 36.1 | 36.1 | 55.5 | 44.9 | 70.0 | 42.4 |
CS | 25.5 | 21.1 | 21.1 | 21.5 | 31.5 | 25.2 | 23.7 | 20.9 | 11.2 | 10.1 |
100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 | 100.0 |
All cause | 20–44 Yrs | 45–64 Yrs | 65+Yrs | 20+ Yrs | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
M | W | M | W | M | W | M | W | Total | ||||
Natural course plus quitters plus new beginners = baseline scenario | 27,789 | 11,155 | 241,401 | 88,257 | 545,869 | 493,782 | 815,059 | 593,193 | 1,408,252 | |||
Various Intervention Scenarios | Tobacco-attributable acute hospital days saved | |||||||||||
M | W | Total | ||||||||||
Taxation change to result in price increases of 10% | 27,635 | 11,102 | 240,316 | 87,898 | 543,801 | 491,614 | 811,753 | 590,614 | 1,402,367 | 3,306 | 2,579 | 5,885 |
IBC* | 27,613 | 11,091 | 240,098 | 87,808 | 542,765 | 491,614 | 810,477 | 590,513 | 1,400,990 | 4,582 | 2,680 | 7,262 |
NRT* | 27,546 | 11,069 | 239,661 | 87,627 | 541,729 | 490,528 | 808,936 | 589,225 | 1,398,161 | 6,123 | 3,968 | 10,091 |
PA* | 27,569 | 11,069 | 239,661 | 87,627 | 541,729 | 490,528 | 808,958 | 589,225 | 1,398,183 | 6,101 | 3,968 | 10,069 |
ALL: taxation, IBC, NRT, PA | - | - | - | - | - | - | - | - | - | 20,111 | 13,196 | 33,307 |
Selected Interventions | M | W | TOTAL |
---|---|---|---|
Baseline | 903,900,431 | 657,851,037 | 1,561,751,468 |
Taxation change to result in price increases of 10% | 900,234,077 | 654,990,926 | 1,555,225,003 |
Difference between baseline and this intervention* | 3,666,354 | 2,860,111 | 6,526,465 |
Relative change between baseline and this intervention | 0.4% | 0.4% | 0.4% |
IBC (assuming 40% coverage based on those willing to quit) | 898,818,993 | 654,878,917 | 1,553,697,910 |
Difference between baseline and this intervention* | 5,081,438 | 2,972,120 | 8,053,558 |
Relative change between baseline and this intervention | 0.6% | 0.5% | 0.5% |
NRT (assuming 40% coverage based on those willing to quit) | 897,110,024 | 653,450,525 | 1,550,560,549 |
Difference between baseline and this intervention* | 6,790,407 | 4,400,512 | 11,190,919 |
Relative change between baseline and this intervention | 0.8% | 0.7% | 0.7% |
PA (assuming 40% coverage based on those willing to quit) | 897,134,422 | 653,450,525 | 1,550,584,947 |
Difference between baseline and this intervention* | 6,766,009 | 4,400,512 | 11,166,521 |
Relative change between baseline and this intervention | 0.7% | 0.7% | 0.7% |
Difference between baseline and all interventions | 22,304,208 | 14,633,255 | 36,937,463 |
Relative change between baseline and all interventions | 2.5% | 2.2% | 2.4% |
© 2009 by the authors; licensee Molecular Diversity Preservation International, Basel, Switzerland. This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
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Popova, S.; Patra, J.; Rehm, J. Avoidable Portion of Tobacco-Attributable Acute Care Hospital Days and Its Cost Due to Implementation of Different Intervention Strategies in Canada. Int. J. Environ. Res. Public Health 2009, 6, 2179-2192. https://doi.org/10.3390/ijerph6082179
Popova S, Patra J, Rehm J. Avoidable Portion of Tobacco-Attributable Acute Care Hospital Days and Its Cost Due to Implementation of Different Intervention Strategies in Canada. International Journal of Environmental Research and Public Health. 2009; 6(8):2179-2192. https://doi.org/10.3390/ijerph6082179
Chicago/Turabian StylePopova, Svetlana, Jayadeep Patra, and Jürgen Rehm. 2009. "Avoidable Portion of Tobacco-Attributable Acute Care Hospital Days and Its Cost Due to Implementation of Different Intervention Strategies in Canada" International Journal of Environmental Research and Public Health 6, no. 8: 2179-2192. https://doi.org/10.3390/ijerph6082179