Vol 39 # 2 June 2007 - Kma.org.kw

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June 2007KUWAIT MEDICAL JOURNAL 1197. Palmieri V, Watchtell K, Gerdts E, et al. Left ventricularfunction and hemodyamic features of inappropriate leftventricular hypertrophy in patients with systemichypertension: The LIFE Study. Am Heart J 2001; 141:784-791.8. Glasser SP. Hypertension syndrome and cardiovascularevents. High blood pre s s u re is only one risk factor.Postgrad Med 2001; 110:29-36.9. B rown MJ, Hydock S. Pathology, epidemiology anddiagnosis of hypertension, Drug 2000; 2:39-40.10. El-Reshid K, Al-Owaish R, Diab A. Hypertension inKuwait: the past, present and future. Saudi J Kidney DisTransplant 1999; 10:357-364.11. British Hypertension Society Guidelines for HypertensionManagement 1999: summary. BMJ 1999; 4:319-633.12. Carghron RF, Smith EL, McClellan-Holm E. Prevention,detection, evaluation and treatment of high blood pressure.South Med J 2001; 94:1074-1095.13. Caughron KF, Smith EL, et al. The six report of the jointcommittee on prevention, detection, evaluation andtreatment of high blood pressure. Arch Intern 1997; 157:2413-2445.14. Daniels SR. Cardiovascular diseases risk factors anda t h e ro s c l e rosis in children and adolescents. Curre n tAtherosclerosis Reports 2001; 3:479-485.15. Riley CK, Terezhaolmy G T. The patient with hypertension.Quintessence International 2001; 32:671-690.16. Logan AG. Screening for hypertension in young and middleaged adults. Canadian task force on preventive health care2002: 217-220.17. Okubo Y, Miyamoto T, Suwazono Y, Kobayashi E, NogawaK. An association between smoking habit and bloodpressure in normotensive Japanese men. J Hum Hypertens2002; 16:91-96.18. Abdul-Rahim HF, Abu-Rmeilehnu NM, Husseini A ,Holmboe OH, Sen G, Jarvell J, Bjertness E. Obesity andselected co-morbidities in an urban Palestinian population.Int J Obes Relat Metab Disord 2002; 269:58-64.19. Mertens IL. Van Gaal LF. Overweight, obesity, and bloodpressure: the effects of modest weight reduction. ObesityResearch 2000; 8:270-278.20. Dickey RA, Janick JJ. Lifestyle modifications in thep revention and treatment of hypertension. EndocrinePractice 2001; 7:392-399.21. Patel JC. Obesity effective and safe management, Indian JMed Sci 2000; 54:499-507.22. Torgerson JS, Sjostrom L. The Swedish obese subjects. Int JObes Relat Metab Disord 2001; 25:1-4.23. Kokikinos PF, Papademetriou V. Exercise and hypertension.Coron Artery Dis 2000; 29:99-102.24. Holmwood C. Over weight and hypertensive. Aust FamPhysician 2000; 29:559-563.25. Ohkubo T, Hozawa A, Nagatomi R, et al. Effect of exercisetraining on home blood pressure values in older adults. Arandomized controlled trial. J Hypertens 2001; 19:1045-1052.26. Deedwania P. Hypertension. ACC Scientific session 2000;3:33-55.27. He J, Bazzano LA. Effects of lifestyle modification ontreatment and prevention of hypertension. Curr Opin inNephrol & Hypertens 2000; 9:267-271.28. Davis MM, Jones DW. The role of lifestyle management inthe overall treatment plan for prevention and managementof hypertension. Semin in Nephrol 2002; 22:35-43.29. Kaplan NM. Guidelines for the management ofhypertension. Can J Cardiol 2000; 16:1147-1152.
KUWAIT MEDICAL JOURNAL June 2007Original ArticleThe Economic Impact of Smoking on the Health System inKuwaitAsia S Al Hamdan 1 , Sana M Al Ali 1 , Sana M Al Mansour 2 , Adel M Al Terkit 3 , Majed A Radwan 31Primary Care, Al-Saqer Health Clinic, Capital Health Region, Kuwait2Primary Care, Al-Yarmok Health Clinic, Capital Health Region, Kuwait3Primary Care, Preventive Health Department, Capital Health Region, KuwaitABSTRACTObjective: To estimate some of the cost and the economicimpact of smoking on health services in KuwaitDesign: A cross-sectional surveySetting: Al-Saqer and Al-Yarmok Primary Care Centers,KuwaitSubjects: Two thousand two hundred and sixteen (2216)male persons were enrolled in this study.Intervention: Each patient was interviewed by a traineddoctor.Main Outcome measures: The incidence of upper andlower respiratory tract system symptoms with currentKuwait Medical Journal 2007, 39 (2):120-125smokers compared to non-smokers.Results: Our study showed a high prevalence of smokingin Kuwait among adult males aged >18 years (40.6 %). Italso showed a high incidence of both upper and lowerrespiratory tract system symptoms with current smokerscompared to non-smokers (67.5 and 76.9% respectivelycompared to 32.5 and 23.1%).C o n c l u s i o n : Smoking increases health care costs byincreasing the number of clinic visits due to respiratoryillness thereby increasing health services utilization andleading to additional societal burden.KEYWORDS: economic, health care cost, health service utilization, smokingINTRODUCTIONThe smoking epidemic has become a matter ofworld-wide concern. It is generally agreed thattobacco use, particularly smoking, poses anenormous public health problem and is stronglyassociated with an increased morbidity andmortality [1] . It remains the number one cause ofpreventable diseases in many countries and theforemost reason for the four primary causes ofdeath (heart diseases, cancer, emphysema andstroke) [2] .It is widely acknowledged that cigare t t esmoking is strongly associated with incre a s e dmorbidity and mortality due to a number ofdiseases, the most recognized of which is lungc a n c e r [ 3 ] . In addition, the various substancescontained in cigarette smoke are partly responsiblefor malignant tumors of the oral cavity and thepharynx. They are a main risk factor for myocardialinfarction, cerebral thrombosis, arteriosclerosis andchronic obstructive pulmonary diseases such asb ronchitis and emphysema [ 4 ] as compared topersons who have never smoked. The averagedecrease in life expectancy has been estimated to be3 - 8 years depending on smoking habits [5] .On reviewing the literature on smoking, wefound that there was a direct link between smokingand various diseases particularly re s p i r a t o r yillnesses. It increases the incidence and the severityof both upper and lower respiratory tractinfections, including acute bronchitis, asthma andcommunity-acquired pneumonia and more severec h ronic lower respiratory tract diseases. In addition,it is estimated that short-term hospital days areincreased by more than 30 percent for diseaseslinked to smoking. Tobacco is a major contributorto these diseases, which now account for more thanhalf the disease burden on countries. This alarmingincreases threatens to undermine their economicand social development [4] .A c c o rding to World Health Org a n i z a t i o n(WHO), there are about 1.1 billion smokersw o r l d w i d e [ 6 ] . The vast majority - 800 millionsmokers - is in developing countries; 700 million ofthese smokers are men. The use of tobaccocurrently account for three million deaths each yearworldwide [7] . The global health care cost resultingfrom tobacco use exceed $200 billion a year - morethan twice the current health budgets of alldeveloping countries combined [8] . It is predictedthat by the 2020s there will be about 10 millionrelated deaths annually worldwide [9] .Address correspondence to:Dr. Asia S. AL Hamdan, Family Physician, Ministry of Health, Primary Health Care, Al-Saqer Clinic, Kuwait. Tel/Fax: (965) 2519490, E-mail:asiaalhamdan@hotmail.com
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