<strong>June</strong> <strong>2007</strong>KUWAIT MEDICAL JOURNAL 123Table 4: Symptoms during the visit to Health Centerwith Smoking StatusSymptom of last visitSmoking statusCurrent Non Totaln (%) n (%)General symptom 1<strong>39</strong> (35.2) 256 (64.8) <strong>39</strong>5Upper respiratory <strong>39</strong>9 (54.7) 330 (45.3) 729Lower respiratory 73 (64.6) 40 (35.4) 113Gastro-intestinal 76 (49.4) 78 (50.6) 154Upper &lower respiratory 16 (80) 4 (20) 20More than one symptom 203 (40.1) 303 (59.9) 506Table 5: Smoking status and the number of visits tohealth center during last six monthsSmoking statusNo. of visits current non Total p value1 - 3 292 521 813 p < 0.0014 - 6 236 202 428 p = 0.0267 - 9 156 52 208 p < 0.00110 - 12 65 21 86 p < 0.001> 12 25 13 38 p = 0.012Chi square = 72.28, Degree of freedom = 5, p value < 0.001Table 6: Smoking status and the number of hospital orprivate clinic visits during last six monthsSmoking statusNo. of visits current non Total p value1 - 2 65 45 110 p = 0.013 - 4 32 14 46 p < 0.0015 - 6 10 6 16 p=0.2(NS)> 7 6 1 7 p = 0.03significant (p < 0.001).Regarding the symptoms at last visit (not theday of the interview) to health center: 64.6% ofcurrent smokers had visited the health center forlower respiratory system symptoms and this wassignificantly higher than the non-smoker group(34.3%, p < 0.001, Table 4). 80% of current smokershad visited the health center for symptoms of bothupper and lower respiratory systems in contrast toonly 20% non-smokers and this was statisticallyhighly significant (p = 0.001).Number of visits to health center during the lastsix months were grouped into intervals (Table 5) , ap value calculated for each group and Normal ZTest used for testing the significance between twoproportions which was highly significant (p
124The Economic Impact of Smoking on Health System in Kuwait <strong>June</strong> <strong>2007</strong>health (2001-2002), the average cost of single visit toGP clinic was equal to 5 KD, while a hospitalcausality visit costs 18 KD. Hospital out-patientvisit costs 40 KD while a hospital admission for oneday costs on an average about 80 KD. Our studyshowed more frequent visits by smokers than nonsmokersto GP clinic and hospitals. 88.9% of currentsmokers had 11 visit per six months to the GP clinicwhich can be considered a burden on health systemservices in a small country like Kuwait with thehigh p revalence of smokers (40.6%). This studyi d e n t i f i e s that burden of smoking on our societywhich consists of these medical costs plusproductivity losses attributable to smoking-relatedmorbidity, disability and premature mortality.In the United States, each year approximately400,000 deaths are attributed to cigarette smokingand costs associated with morbidity attributed tosmoking are substantial [22] . It is estimated that 60%of the direct health care costs in the US go to treattobacco related illnesses [23] .As regards the number of visits to the healthcenter during last six months, we found that thehigher the number of visits higher is the re l a t i o n s h i pto current smokers. This is an indication thatcurrent smokers are using health services moreoften than non-smokers. This may be explained bythe fact that smoking causes chronic healthproblems requiring more visits. Treating tobaccodependence produces a strong return oninvestment by reducing substantially the high costof treating chronic respiratory diseases, myocardialinfarctions and cancers caused by smoking [24] .There was no big difference between smokersand non-smokers when asked about symptomsduring their last visit to the hospital, except forlower respiratory tract symptoms. This was higherin smokers than non-smokers. This is consistentwith many studies that emphasize smoking as acausative agent for respiratory tract illnesses [1,4,21,25] .It was obvious throughout this study thatnumbers of visits to hospitals or private clinics ishigher for current smokers than for non-smokers.We tried to obtain information on all kinds ofhealth seeking behaviour, either at a government orprivate facility, to know the frequency of visits sothat we could estimate the cost of smoking and itsburden either on individual or national level. Wefound a higher number of visits by current smokersthan non-smokers which reflects an additionaleconomic burden .Comparing current smokers with non-smokersas re g a rds the number of visits to a specialpharmacy to seek medications without prescriptionduring last six months, there was insignificantdifference between the two groups.In most countries the re s o u rces devoted tohealth care are increasing and diseases caused bysmoking are a major reason for this increase. Theemphasis of public health policies tends to bestrongly on curative care. Less emphasis is placedon preventive programs which are often viewed asless urgent and less important because they are lessspecific and are focused on groups withinpopulation who may still be healthy. Althoughthese can make a major impact on health educationand economic strategies, these strategies are moreeffective when used in combination [26] .Countries that adopted comprehensive controlson the use of tobacco indoors, high taxes on tobaccoproducts, smoking cessation programs and healtheducation have had considerable success inreducing costs of health care [27] .The smoking-attributable costs described instudies are underestimated for two reasons [28] . First,the cost estimates do not include all direct medicalcosts attributable to cigarette smoking (e.g., burncare resulting from cigarette-smoking-related firesand costs associated with diseases caused bye x p o s u re to environmental tobacco smoke).Second, the indirect costs of morbidity (e.g., due towork loss and bed-disability days) and loss inproductivity resulting from the premature deathsof smokers and former smokers was not includedin these estimates. This suggests that the totaleconomic burden of cigarette smoking is more thantwice as high as the direct medical costs.CONCLUSIONOur survey showed a high prevalence ofsmoking among adult males >18 years old (40.6%).Smokers had more visits to health centers forrespiratory conditions than non smokers leading toan enormous economic burden on the health careservices utilization, thereby increasing health carecost. Smoking cessation programs should bestrengthened to decrease number of smokers in thecommunity and thus decrease illnesses related tosmoking and the overall societal burden.REFERENCES1. Hoffman LH, Strutton DR, Stang PE, Hogue SL. Impact ofSmoking on Respiratory Illness-Related Outpatient VisitsAmong 50-75 Years-Olds in the United States. Clin Ther2002; 24:317-324.2. Thomas LA. Sending unhealthy environments up in smoke.Mich Health Hosp 2002; 38:20-21.3. Doll R, Hill AB. Study of the aetiology of carcinoma of thelung. BMJ 1952; 2:1271-1286.4. Ruff LK, <strong>Vol</strong>mer T, Nowak D, Meyer A. The economicimpact of smoking in Germany. European RespiratoryJournal 2000; 16:385-<strong>39</strong>0.5. West RR. Smoking: its influence on survival and causes ofdeath. J Coll Physicians Lond 1992; 26:357-366.
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