Long term health risks also much higher despite lower smoking rates + more quit attempts
Minority adults who smoke stand to benefit more from tobacco control policies

The annual tobacco-related healthcare spend of US Minorities who smoke is double that of White adults who smoke, finds an analysis of national health and medical spend survey data, published online in the journal Tobacco Control. 

And the excess risks of 3 or more long term health conditions associated with smoking are more than 40% higher among Minority adults, despite their lower smoking rates and more numerous quit attempts than their White peers, the analysis indicates.

The findings prompt the researchers to conclude that Minority adults who smoke stand to benefit substantially more from tobacco control policies than do White adults who smoke.

Each year, 480,000 people die before their time from diseases linked to smoking, making tobacco use the leading cause of preventable illness and death in the USA, note the researchers.

In 2022, the US Food and Drug Administration proposed regulations that would set a maximum nicotine level to help reduce the addictiveness of cigarettes and stop an estimated 33 million people from smoking by 2100.

But this type of far-reaching regulation requires the Office of Management and Budget (OMB)–the office that assists the US President to develop and execute policies–to prove that the benefits would outweigh the costs. 

And earlier this year, the President requested that cost-benefit analyses for new tobacco control regulations should account for their impact on different sectors of the population.

For the first time, therefore, the researchers estimated the racial and ethnic disparities in medical spending and health outcomes associated with smoking in the US.

They linked data from the 2008-19 Medical Expenditure Panel Survey (Household Component) and the National Health Interview Survey for 118, 084 adults to estimate the proportion of the top 10 health conditions and annual healthcare spend—adjusted for inflation—attributable to smoking by race and ethnicity.

Between 2008 and 2019, 15% of Minority adults smoked, compared with 17% of White adults, who smoked the most cigarettes every day: 14 vs 9. 

While the proportion of White adults trying to quit smoking fell to 53% in 2019, this increased to 63% for Minorities. 

Tobacco related health issues accounted for just under 12% of the  total yearly medical care spend ($876 out of $7208) for White adults who smoked, but were twice as much—25% ($1509 of the $6253)—for Minority adults who smoked, primarily driven by Hispanic and other racial groups.

 Minority adults were also significantly more likely to have 3 or more of the top 10 conditions associated with smoking in the US: high cholesterol; high blood pressure; diabetes; joint pain; cancer; heart attack; arthritis; asthma; heart disease; and stroke. They were 34% more likely to do so compared with 24% for White adults who smoked.

Between 2008 and 2016, smoking comprised 7.5% of the nation’s total healthcare spend for White adults and nearly 11% for Minority adults. 

In 2017–19, this had fallen to 2.5% for White adults but only 9% for Minority adults, indicating that they have not benefited much from the medical cost savings associated with the large reduction in smoking rates over the decades, say the researchers.

Based on these data, the researchers estimated that any new tobacco control regulations would save $134 million a year for every 100,000 Minority adults who didn’t start smoking— 135% more than the $57 million for the same number of White adults.

This would also save federal healthcare programmes $83 million a year for every 100,000 adults not taking up smoking—$60 million from Minority adults and $23 million from White adults, the researchers add.

They acknowledge various limitations to their findings. These include an exclusive focus on cigarettes rather than other tobacco products or vapes, and the exclusion of the military and  prison populations as well as nursing home spend from their calculations. 

But they nevertheless conclude: “Our results indicate that the Minority population will benefit much more than the White population under anti tobacco regulations that reduce smoking, exemplifying the importance of agencies including such distributional analyses in their regulatory cost benefit analyses.”


Notes for editors
 Racial and ethnic disparities in healthcare costs and outcomes of cigarette smoking in USA: 2008–2019 doi 10.1136/tc-2023-058136
Journal: Tobacco Control

Funding: None declared 

Link to Academy of Medical Sciences press release labelling system

Externally peer reviewed? Yes
Evidence type: Observational; data analysis
Subjects: People