摘要：Objectives. We estimated the economic impact of smoking on African Americans in California in 2002, including smoking-attributable health care expenditures and productivity losses from smoking-caused mortality. Methods . We estimated econometric models of smoking-attributable ambulatory care, prescription drugs, inpatient care, and home health care using national and state survey data. We assessed smoking-attributable mortality using epidemiological models. Results . Adult smoking prevalence for African Americans was 19.3% compared with 15.4% for all Californians. The health care cost of smoking was $626 million for the African American community. A total of 3013 African American Californians died of smoking-attributable illness in 2002, representing a loss of over 49 000 years of life and $784 million in productivity. The total cost of smoking for this community amounted to $1.4 billion, or $1.8 billion expressed in 2008 dollars. Conclusions . Although African Americans account for 6% of the California adult population, they account for over 8% of smoking-attributable expenditures and fully 13% of smoking-attributable mortality costs. Our findings confirm the need to tailor tobacco control programs to African Americans to mitigate the disproportionate burden of smoking for this community. Cigarette smoking continues to be a major public health hazard in the United States. Each year, over 440 000 Americans die from cigarette smoking. 1 Smoking accounts for 1 of every 5 deaths and leads to substantial health care costs and lost productivity. 2 – 5 Minority groups have the highest illness and mortality rates, and among them, African Americans bear the greatest burden. 6 – 8 African American adults are more likely to die from 3 leading causes of smoking-related death—coronary heart disease, stroke, and lung cancer—than other adults. 7 They have high rates of tobacco-related cancer. 9 Although smoking prevalence has declined among African American adults since 1990, as it has among the general population, it remains unacceptably high. In the United States in 2007, smoking prevalence was higher among African American men than among White men (24.8% versus 23.1%) but lower among African American women than among White women (15.8% versus 19.8%). 10 In California in 2005, the highest adult smoking prevalence was among African Americans (18.9%), compared with 14.5% among Whites, 11.8% among Hispanics, and 11.0% among Asian/Pacific Islanders. 11 Although there is a growing body of evidence documenting the high rates of smoking and smoking-related disease among African Americans, research documenting the resulting economic impact is lacking. We estimated the economic impact of smoking for the African American community in California for 2002, which will be useful for guiding policymakers and advocates to develop programs and policies that can mitigate the impact of smoking for this population. We developed 2 measures of economic impact: smoking-attributable health care expenditures and productivity losses resulting from smoking-attributable mortality.
