title: The healthcare costs of secondhand smoke exposure in rural China.
abstract: OBJECTIVE
  The goal of this study was to assess the healthcare costs attributable to secondhand smoke (SHS) exposure among non-smoking adults (age ≥ 19) in rural China.
  
  
  METHODS
  We analysed data from the 2011 National Rural Household Survey which was conducted among adults in five provinces and one municipality in China (N=12,397). Respondents reported their smoking status, health conditions and healthcare expenditures. Relative risks were obtained from published sources. Healthcare costs included annual outpatient and inpatient hospitalisation expenditures for five SHS-related diseases: asthma, breast cancer (female only), heart disease, lung cancer and tuberculosis. SHS-attributable healthcare costs were estimated using a prevalence-based annual cost approach.
  
  
  RESULTS
  The total healthcare costs of SHS exposure in rural China amounted to $1.2 billion in 2011, including $559 million for outpatient visits and $612.4 million for inpatient hospitalisations. The healthcare costs for women and men were $877.1 million and $294.3 million, respectively. Heart disease was the most costly condition for both women ($701.7 million) and men ($180.6 million). The total healthcare costs of SHS exposure in rural China accounted to 0.3% of China's national healthcare expenditures in 2011. Over one-fifth of the total healthcare costs of SHS exposure in rural China were paid by health insurance. The out-of-pocket expenditures per person accounted for almost half (47%) of their daily income.
  
  
  CONCLUSIONS
  The adverse health effects of SHS exposure result in a large economic burden in China. Tobacco control policies that reduce SHS exposure could have an impact on reducing healthcare costs in China.
authors.affiliation: Institute for Health & Aging, University of California, San Francisco, California, USA Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA.
authors.forename: Tingting
authors.initials: T
authors.lastname: Yao
authors.affiliation: Institute for Health & Aging, University of California, San Francisco, California, USA.
authors.forename: Hai-Yen
authors.initials: HY
authors.lastname: Sung
authors.affiliation: Huaxi School of Public Health, Sichuan University, Chengdu, China.
authors.forename: Zhengzhong
authors.initials: Z
authors.lastname: Mao
authors.affiliation: Center for International Tobacco Control, Public Health Institute, Oakland, California, USA School of Public Health, University of California, Berkeley, California, USA.
authors.forename: Teh-wei
authors.initials: TW
authors.lastname: Hu
authors.affiliation: Institute for Health & Aging, University of California, San Francisco, California, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Max
mesh_terms: D000328:Adult; D001249:Asthma / Q000191:economics / Q000209:etiology; D002681:China; D017281:Cost of Illness; D004781:Environmental Exposure / Q000009:adverse effects*; D005191:Family Characteristics; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006331:Heart Diseases / Q000191:economics / Q000209:etiology; D006760:Hospitalization; D006801:Humans; D007348:Insurance, Health; D008297:Male; D009369:Neoplasms / Q000191:economics / Q000209:etiology; D012424:Rural Population; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000191:economics*; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000009:adverse effects / Q000191:economics*; D014376:Tuberculosis / Q000191:economics / Q000209:etiology
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Economics; Global health; Low/Middle income country; Public policy; Secondhand smoke