title: Annual healthcare spending attributable to cigarette smoking: an update.
abstract: BACKGROUND
  Fifty years after the first Surgeon General's report, tobacco use remains the nation's leading preventable cause of death and disease, despite declines in adult cigarette smoking prevalence. Smoking-attributable healthcare spending is an important part of overall smoking-attributable costs in the U.S.
  
  
  OBJECTIVE
  To update annual smoking-attributable healthcare spending in the U.S. and provide smoking-attributable healthcare spending estimates by payer (e.g., Medicare, Medicaid, private insurance) or type of medical services.
  
  
  METHODS
  Analyses used data from the 2006-2010 Medical Expenditure Panel Survey linked to the 2004-2009 National Health Interview Survey. Estimates from two-part models were combined to predict the share of annual healthcare spending that could be attributable to cigarette smoking. The analysis was conducted in 2013.
  
  
  RESULTS
  By 2010, 8.7% (95% CI=6.8%, 11.2%) of annual healthcare spending in the U.S. could be attributed to cigarette smoking, amounting to as much as $170 billion per year. More than 60% of the attributable spending was paid by public programs, including Medicare, other federally sponsored programs, or Medicaid.
  
  
  CONCLUSIONS
  These findings indicate that comprehensive tobacco control programs and policies are still needed to continue progress toward ending the tobacco epidemic in the U.S. 50 years after the release of the first Surgeon General's report on smoking and health.
authors.affiliation: Office on Smoking and Health (Xu, Pechacek), National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia. Electronic address: xinxu@cdc.gov.
authors.forename: Xin
authors.initials: X
authors.lastname: Xu
authors.affiliation: Department of Biostatistics & Epidemiology (Bishop, Kennedy, Simpson), RTI International, Research Triangle Park, North Carolina.
authors.forename: Ellen E
authors.initials: EE
authors.lastname: Bishop
authors.affiliation: Department of Biostatistics & Epidemiology (Bishop, Kennedy, Simpson), RTI International, Research Triangle Park, North Carolina.
authors.forename: Sara M
authors.initials: SM
authors.lastname: Kennedy
authors.affiliation: Department of Biostatistics & Epidemiology (Bishop, Kennedy, Simpson), RTI International, Research Triangle Park, North Carolina.
authors.forename: Sean A
authors.initials: SA
authors.lastname: Simpson
authors.affiliation: Office on Smoking and Health (Xu, Pechacek), National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia.
authors.forename: Terry F
authors.initials: TF
authors.lastname: Pechacek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D015992:Body Mass Index; D015438:Health Behavior; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D012907:Smoking / Q000191:economics* / Q000453:epidemiology*; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult