NGHIÊN CỨU GÁNH NẶNG KINH TẾ XÃ HỘI ĐỐI VỚI PHƠI NHIỄM THUỐC LÁ CHỦ YẾU VỀ BỆNH TIM MẠCH Ở VÙNG NÔNG THÔN_TÂY NAM TRUNG QUỐC

NGHIÊN CỨU GÁNH NẶNG KINH TẾ XÃ HỘI ĐỐI VỚI PHƠI NHIỄM THUỐC LÁ CHỦ YẾU VỀ BỆNH TIM MẠCH Ở VÙNG NÔNG THÔN_TÂY NAM TRUNG QUỐCThe economic burden of tobacco exposurerelate major cadiovascular diseases in rural SouthWest ChinaBệnh tim mạch (CVD) là một vấn đề y tế công cộng quan trong trên thế giới hiên tại. Ước tính gây nên một nửa số ca tủ vong do bệnh không lây nhiễm.Hút thuốc lá là một yếu tố nguy cơ độc lập gây nên bệnh tim mạch; Hút thuốc thụ động (SHS) cũng được nhiều nghiên cứu chứng minh là yếu tố gây nên CVD.

The economic burden of tobacco

exposure-related major cardiovascular diseases in rural south- west China

Cai Le, MD, Ph.D.

Professor School of Public Health Kunming Medical University

 Cardiovascular diseases (CVD) are a major

public health concern in the world, accounting for half of all non-communicable disease deaths

worldwide China is also experiencing an epidem

ic of CVD during recent decades

 Smoking was an independent risk factor for

CVD, and secondhand smoke (SHS) is also dem onstrated to be an established cause of CVD in previous studies

 As one of the most costly diseases, CVD

represents a major economic burden on

healthcare systems However, the literature

on the economic consequences of CVD

associated with tobacco use is still sparse in China

Methodology

Study area and population

 This study was a community-based, cross-sectional survey conducted in four rural areas of Yunnan

province, China

 Yunnan is located in southwest China and had a

recorded population of 45.9 million people

 Yunnan is a production and consumption hub for

tobacco products, tobacco is cultivated in 45 of the province’s counties and more than 2.3 million

farmers in the province are engaged in tobacco

cultivation

Data source

 Information regarding the prevalence,

economic consequences and related aspects

of CHD and stroke, smoking habits, and

exposure to SHS in rural areas of Yunnan

province were obtained from a

community-based cross-sectional health interview and

examination survey

Sampling technique

 A multi-stage stratified random sampling

method was used to select individuals aged

≥18 years from a total of 44 townships in

Yunnan province

Multi-stage stratified random sampling

129 Counties in Yunnan Province

Tobacco cultivation areas

Economically disadvantaged

Economically advantaged

Economically disadvantaged Non-tobacco cultivation areas

Data collection

personally interviewed face-to-face by trained

interviewers, using a pre-tested structured questionnaire Information on demographic characteristics, self-

reported smoking habits, annual disease specific

inpatients hospitalization expenditures, expenditures for outpatient visit and self-medication, direct non-medical costs, and work absence due to target disease were

obtained through the questionnaire

 CHD and stroke was identified by

self-reported physician diagnosis

 Smokers were defined as persons who had smoked at least 100 cigarettes in their

lifetime

 Exposure to SHS was defined as

non-smokers who reported exposure to

environmental tobacco smoke at home or at work for a minimum of 15 minutes at least one day per week

Calculation of Population Attributable Fraction (PAF)

Where: P denotes to the prevalence of

smoking or exposure to SHS in a given

population, and OR denotes odds ratio for disease-specific morbidity caused by

smoking or exposure to SHS

%

100 1

) 1 (

) 1

OR P

PAF

Calculation of direct costs

 The costs associated with outpatient/inpatient visits were estimated by multiplying the

number of outpatient visits/inpatient hospital admissions related to CVD by the

outpatient/inpatient unit costs per year

Calculation of indirect costs

 Indirect costs were estimated as the earnings lost as a result of CVD-related morbidity

using the “human capital” approach

Statistical analysis

 Descriptive analysis techniques and

multivariate logistic regression were used in this study All data analyses were conducted with R2.9.2 software

Results

Demographic characteristics of

the study population

 A total of 18,000 individuals

aged ≥18 years were asked

to participate in this study

 Participants in the study

included 8,156 males and

Prevalence of smoking, SHS ,

and CVD

 The overall prevalence of smoking and

exposure to SHS in the study population was 35.5% and 42.2, respectively

 The overall prevalence of stroke and CHD

was 1.0% and 1.7% among the surveyed

population, respectively

OR and PAF% of major cardiovascular

diseases associated with smoking and SHS

Variables

Smoking

Secondhand smoke exposure

(SHS) Multivariable

adjusted OR † (95% CI)

PAF(%)

Multivariable adjusted OR † (95% CI)

PAF(%)

Stroke

Male 2.42** (1.28, 4.58) 50.93 2.32** (1.26, 4.25) 33.98 Female 4.01* (1.38, 11.68) 3.77 1.92** (1.18, 3.11) 28.39 All 2.46** (1.67, 3.64) 34.14 2.04** (1.39, 2.97) 30.50 CHD

Male 8.32** (3.88, 17.87) 84.25 3.54** (2.14, 5.87) 49.76 Female 4.27** (1.85, 9.84) 4.08 1.60** (1.14, 2.23) 20.55 All 5.34** (3.15, 9.03) 60.64 1.94** (1.45, 2.59) 28.40

OR and PAF% of major cardiovascular

diseases associated with smoking and SHS

 There were significant positive associations between smoking, exposure to SHS and risk for stroke and CVD for both sexes

Cost of illness of major cardiovascular

diseases (in US$) in rural southwest China

Cost components

Stroke Coronary heart disease Unit cost Total

(million )

Unit cost Total

(million) Male Female All Male Femal e All

Direct medical

costs 1238.0 1565.0 1406.8 8.71 2324.6 1331.7 1738.0 16.16 Outpatient visits 13.70 35.6 26.2 0.16 42.3 30.62 34.5 0.32 Hospitalization 1048.3 1292.0 1171.9 7.26 1928.4 1052.5 1415.2 13.16 Self-medication 176.04 237.42 208.7 1.29 353.8 248.6 288.3 2.68 Direct non-medical

costs 19.43 102.21 60.03 0.37 31.9 59.3 48.6 0.45 Total direct costs 1257.4 1667.2 1466.8 9.08 2356.5 1391.1 1786.6 16.61 Total indirect costs 9.82 23.12 19.3 0.12 14.5 39.1 31.2 0.29 Total cost of

illness 1267.2 1690.4 1486.2 9.2 2371.0 1430.2 1817.9 16.9

Cost of illness of major cardiovascular

diseases (in US$) in rural southwest China

 Males had higher unit costs of illness due to CHD than females, whereas unit costs of

illness due to stroke were higher in females than in males (P<0.05)

 Inpatient hospitalizations represented the

main component of direct costs of CVD, and direct costs were the main drivers of the

economic burden of CVD

Cost of CVD attributable to smoking

and exposure to SHS

Variables

Costs of illness attributable to

smoking (million)

Costs of illness attributable to secondhand smoke exposure

(million) Direct

costs

Indirect costs

Total cost

of illness

Direct costs

Indirect costs

Total cost

of illness Stroke

Male 3.97 0.31 4.28 2.65 0.21 2.86 Female 0.37 0.05 0.42 2.77 0.38 3.15 All 4.34 0.36 4.70 5.42 0.59 6.01 CHD

Male 15.55 0.01 15.56 10.9 0.07 10.97 Female 0.03 0.002 0.03 3.18 0.09 3.27 All 15.58 0.01 15.59 14.08 0.16 14.24

Cost of CVD attributable to

smoking and exposure to SHS

 The cost of CVD attributable to smoking and exposure to SHS accounting for 1.76% and 1.89% of local healthcare costs, respectively

 Smoking contributed more economic burden

of CVD than exposure to SHS in men,

whereas exposure to SHS contributed more economic burden of CVD than smoking in

women

 Both smoking and exposure to SHS were

associated with an increased risk of CVD

 Smoking and exposure to SHS produce

substantial economic burden as well as have

a considerable public health impact in rural southwest China

Thank you!