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

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