title: Excess morbidity and expenditure on healthcare in families with smokers: a community study.
abstract: BACKGROUND
  There is paucity of information on health-related expenditure attributed to smoking in India. This community study estimated the expenditure on healthcare and morbidity borne by families of smokers and compared these with those of families without smokers. It was hypothesized that families with smokers were likely to have a higher health expenditure than non-smoker families attributable to the increased probability of health problems associated with smoking.
  
  
  METHODS
  The study population comprised 1000 urban and rural families divided into two groups. Group I consisted of 500 families with one or more smoker(s) while group II comprised 500 families without a smoker. Both groups had an equal representation from the urban and rural populations (250 each). The study team used a structured, generally close-ended questionnaire, pre-tested for its validity and reliability, to interview the families. Different components of health-related expenditure and other morbidity indices were studied. Each family was studied in two phases: (i) initially, for the retrospective assessment of expenditure and other losses during the preceding one year, and (ii) prospectively, for the following 10 months on repeated visits and estimations made every two months. The data collected retrospectively were mostly incomplete and could not be used for analyses.
  
  
  RESULTS
  The number of family members reporting sick was significantly higher in group I than in group II among both urban and rural families (p < 0.001). There was an excess expenditure of Rs 730 and Rs 141, in addition to Rs 4209 and Rs 894 on smoking products in group I families in urban and rural areas, respectively. Univariate analysis showed that the odds ratio for having any health-related expenditure for a group I family was 3.346 (95% confidence interval 2.533-4.420), which was highly significant (p < 0.0001). The differences in loss of work on account of illness and loss of man-days among members of groups I and II were not significant. However, the number of lost school days among children of group I families, loss of efficiency of its members and change of jobs due to loss of efficiency were highly significant.
  
  
  CONCLUSIONS
  The direct healthcare costs as well as the indirect fiscal losses are higher in families with one or more smoker(s).
authors.affiliation: Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. skjindal@indiachest.org
authors.forename: S K
authors.initials: SK
authors.lastname: Jindal
authors.forename: R P
authors.initials: RP
authors.lastname: Sapru
authors.forename: A N
authors.initials: AN
authors.lastname: Aggarwal
authors.forename: K
authors.initials: K
authors.lastname: Chaudhry
mesh_terms: D005192:Family Health; D017048:Health Care Costs; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D009017:Morbidity; D012111:Residence Characteristics; D012423:Rural Health; D012907:Smoking / Q000009:adverse effects* / Q000191:economics; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000150:complications* / Q000191:economics; D014504:Urban Health