e-Cigarette Use Linked to $15 Billion in Health Care Expenses in 2018

Using e-cigarettes as an adult is associated with substantially increased health care utilization and expenses that are likely to increase more over time, a study published in Tobacco Control found.

Since their introduction to the US market, e-cigarettes have continuously gained popularity, especially among middle schoolers, high schoolers, and young adults aged younger than 24 years. Between 2012 and 2018, active e-cigarette use increased from 2.4% to 7.6% among young adults, with a 3.2% prevalence among all US adults in 2018.

While there has been research on health care expenditures relating to traditional cigarettes and other tobacco products as well as the health effects of e-cigarettes, there were no studies on the impact of e-cigarettes on health care utilization and expenses before this one.

The study authors’ goal was to estimate annual health care expenditures attributable to e-cigarette use among US adults aged 18 and older.

To do so, they analyzed data of 109,133 adults collected by the National Health Interview Survey between 2015 and 2018. Current e-cigarette users were defined as individuals who have ever used e-cigarettes and reported either currently using e-cigarettes every day or some days, or using e-cigarettes at least once in the past 30 days.

All current e-cigarette users were further classified into 2 categories:

• Current exclusive e-cigarette users, who have smoked less than 100 traditional cigarettes in their lifetime and never smoked cigars, pipes, or smokeless tobacco
• Current dual/poly e-cigarette users, who have smoked at least 100 cigarettes in their lifetime and/or have ever smoked cigars, pipes, or smokeless tobacco

The study also included never tobacco users, who have never used e-cigarettes, smoked less than 100 traditional cigarettes in their lifetime, and have never smoked cigars, pipes, or smokeless tobacco. Remaining participants made up the “other tobacco users” group.

During the 2015-2018 period, the prevalence of exclusive e-cigarette use was 0.2% and poly e-cigarette was 3.5%, and both were associated with higher odds of reporting poor health status, compared with individuals who never used tobacco.

Of the 3.7% current e-cigarette users, 47.3% were male, 50.8% were aged between 35 and 64 years.

Sociodemographic factors and other characteristic were also taken into account. Nearly a quarter (24.4%) of current users were heavy drinkers, defined as men who drank at least 5 alcoholic beverages in a sitting or women who drank at least 4 alcoholic beverages in a sitting at least once in the past year.

Additionally, 86.9% had full-coverage health insurance, and 13.2% reported fair or poor health.

Health care utilization included overnight hospital stays, emergency department (ED) visits, and doctor and home visits. The prevalence of health care utilization within the past 12-months was 9.1% for hospitalizations, 19.6% for ED visits, 84.1% for doctor visits, and 3.0% for home visits.

The authors’ econometric model included 2 equations: health status as a function of e-cigarette use and other independent variables, and health care utilization as a function of health status, e-cigarette use, and other independent variables.

Based on the first equation, current exclusive and poly e-cigarette users were 1.62 times and 1.75 times more likely to report poor health status compared with never tobacco users, respectively

Based on the second equation, predicted poor health status was significantly associated with increased likelihood of utilizing all 4 health care services included in this study, as well as an increase in ER visits and doctor visits in the past 12 months.

“Using an ‘excess utilisation’ approach, we multiplied the e-cigarette–attributable fraction derived from the model by annual health expenditures to calculate healthcare expenditures attributable to current exclusive and dual/poly e-cigarette use, the sum of which were expenditures attributable to all current e-cigarette use,” they explained.

This excess utilization equation demonstrated that annual health care expenditures attributable to all current e-cigarette use totaled $15.1 billion or $2024 per person in 2018. This includes $1.3 billion attributable to exclusive e-cigarette use ($1796 per person) and $13.8 billion attributable to poly e-cigarette use ($2050 per person).

“Due to the rapid evolution of e-cigarette products, the impacts of e-cigarette use on healthcare utilisation and expenditures may change and should be closely monitored,” the authors concluded. “The challenges of e-cigarettes for public health are global and our findings regarding the economic burden of e-cigarette use in the USA have broader relevance in an international context.”

Reference

Wang Y, Sung HY, Lightwood J, Yao T, Max WB. Healthcare utilisation and expenditures attributable to current e-cigarette use among US adults. Tob Control. Published online May 23, 2022. doi:10.1136/tobaccocontrol-2021-057058