One way to assess the effect of smoking is to translate the associated medical care burden into dollars, the universal language of decision makers. The total cost of smoking in the United States amounted to an astounding $72.7 billion in 1993. As reported in the September/October issue of Public Health Reports, it is estimated that more than one out of nine (11.1%) personal health care dollars are spent on care of people with smoking-related diseases, according to researchers at the University of California at Berkeley and San Francisco.

Among the individual states, the estimated proportion of medical expenditures consumed by smoking-related diseases range from a low of 6.6% in Utah to a high of 14.1% in Nevada. In dollar terms, several states (Alaska, Idaho, South Dakota, Vermont, and Wyoming) spent less than $200 million, while California and New York spent $8.7 billion and $6.6 billion, respectively. [Request related table for complete state data: Public Health Reports, tel. 617-565-1440; email ] State variations result from differences in smoking prevalence, health status, socioeconomic variables, and the magnitude and patterns of medical expenditures in each state.

The researchers also found variations in the proportions of total smoking-related medical expenditures spent on different types of medical care. Nationally, estimates of 8.0% of home health care, 9.2% of ambulatory care, 11.3% of prescription drug, 13.3% of hospital care, and 15.9% of nursing home care expenditures were attributable to smoking.

Estimated Medicaid expenditures attributed to smoking, reported by the authors in the March/April issue of Public Health Reports, amounted to $12.9 billion, 17.7% of the total reported in the current article.

The authors point out that these estimates can be used by states in many ways: to define the impact of cigarette smoking on the delivery and financing of medical care services; to justify economic interventions such as increases in cigarette taxes; to guide health policy and planning relative to smoking control initiatives; and to provide an economic framework for program evaluation.

StateAmbulatory
carePrescription
drugsHospital
careHome
health servicesNursingAll
types       United States18,529.807,677.9235,914.361,733.888,876.5372,732.49       Alabama186.3893.59429.3131.2562.56803.09Alaska40.2018.2686.870.398.16153.88Arizona252.58105.19411.8319.7187.24876.55Arkansas133.9070.51315.4210.9473.32604.08California2,963.42936.014,051.04124.32641.468,716.25Colorado270.2298.22454.4913.70102.51939.15Connecticut271.42126.09511.4532.80258.301200.06Delaware53.6822.31110.924.0133.46224.39Dist. of Columbia62.1414.48215.763.0920.10315.57Florida1,290.32494.932,130.67198.60512.144,626.65Georgia436.44201.57901.0046.14120.961706.11Hawaii82.3045.40169.922.3128.19328.12Idaho45.8523.9986.752.8819.74179.20Illinois661.52294.461,600.2453.27358.962,968.46Indiana364.40164.17768.3321.03241.911,559.84Iowa142.7169.67302.098.2894.29617.05Kansas150.5969.57309.0111.0194.04634.22Kentucky223.47126.42528.6124.81119.951,023.27Louisiana236.53121.06633.6727.92127.391,146.57Maine72.0737.70156.309.0662.85337.98Maryland362.79187.25634.4923.21170.991,378.73Massachusetts560.55218.461,175.4977.51425.482,457.48Michigan636.42305.141,329.1552.92256.372,580.00Minnesota386.57108.60470.1129.32219.661,214.26Mississippi107.2168.36300.4819.3353.39548.77Missouri333.96139.96829.9323.01175.271,502.13Montana47.7722.28103.533.7128.06205.35Nebraska86.7339.32203.634.9361.87396.49Nevada125.2652.76199.0110.7330.17417.93New Hampshire97.0635.68160.146.4448.70348.01New Jersey646.85270.941,262.6765.30336.812,582.57New Mexico77.4445.38210.314.4527.45365.04New York1,485.44558.223,164.86303.851,135.826,648.19North Carolina398.71199.78851.0237.91181.611,669.03North Dakota42.4815.0593.441.0728.03180.07Ohio791.61338.411,648.7449.07541.783,369.62Oklahoma177.5286.70342.1316.1871.04693.57Oregon204.1580.27335.748.9397.37726.46Pennsylvania913.99367.522,095.0862.89568.844,008.31Rhode Island77.4535.54158.869.2267.26348.34South Carolina171.6793.39429.3913.9060.13768.47South Dakota37.1215.5695.171.0724.90173.82Tennessee307.55152.28744.5154.87130.041,389.25Texas1,155.17526.592,587.02117.91435.284,821.98Utah56.8126.28105.523.9816.73209.31Vermont33.0217.9465.264.5724.88145.67Virginia373.49181.29659.2423.40104.001,341.42Washington393.01151.81586.3126.30175.471,332.91West Virginia106.0657.87263.7310.5055.01493.17Wisconsin378.03135.08596.9720.06245.911,376.05Wyoming17.7610.6538.711.8410.6879.64

NOTE: SAEs exclude amounts spent for people younger than 19 years, psychiatric hospital care, and mental retardation nursing homes. aNo BRFSS dataset was available for Wyoming. The Wyoming SAFs were computed as the mean of the SAFs of its contiguous states: Montana, Idaho, Utah, Colorado, South Dakota, and Nebraska.

CONTACT: Leonard S. Miller, PhD, School of Social Welfare, UC Berkeley, tel. 925-370-6439; fax 925-370-6419. Other Authors: Xiulan Zhang, MS; Dorothy P. Rice, UC San Fransciso, tel. 415-476-2771; Wendy Max, PhD.