TOBACCO IS KILLING (AND COSTING) US

A Report on Tobacco Use Rates, Smoking-Related Deaths,
and Smoking-Related Health Care Costs in West Virginia

The Health Statistics Center relied upon the work of two noted researchers in estimating smoking-attributable direct health care costs. Vincent Miller and Leonard Miller (not related) independently developed two models for estimating health care costs related to cigarette smoking (1,2). At the core of both models is the concept of the smoking-attributable fraction (SAF), which is the proportion of the average medical care expenditure for a specific category (e.g., hospital care, ambulatory care, or prescription drugs) that is due to cigarette smoking. Simply stated, an SAF expresses the ratio of the cost difference between smokers and nonsmokers for each medical expense category. Health Statistics Center staff elected to show the results of both models after consultation with Dr. Jeffery Fellows of the Centers for Disease Control and Prevention. The SAFs from both models were applied to estimated health care expenditures for West Virginia obtained from the federal Health Care Financing Administration. In the present report, Model 1 refers to the use of SAFs calculated by Vincent Miller et al. and Model 2 the use of SAFs calculated by Leonard Miller et al. West Virginia’s total smoking-related direct health care costs for 2004 are estimated at $846 million using Model 1 and over $1.064 billion using Model 2.

Mortality-Related Productivity Costs
The SAMMEC software used to update the smoking–related mortality data presented in this report also calculated mortality-related productivity losses that are attributable to smoking, that is, losses resulting from premature death due to smoking-related disease. These data are calculated using updated age-specific estimates of the present value of future earnings (PVFE) from paid market and unpaid household work, as obtained from Haddix et al. (7).

Using SAMMEC, it was estimated that smoking-attributable productivity losses in West Virginia amounted to $834 million in the year 1999. Adjusting to the year 2001 using Employment Cost Index (ECI) estimates for total compensation (after consultation with the Office on Smoking and Health [OSH] at CDC), it was estimated that the corresponding productivity losses for the year 2001 amounted to $906 million. This same method was used to estimate the 2004 productivity losses. The ECI yielded an 11.76 percent increase in losses between the 3rd quarter of 2001 and the 3rd quarter of 2004. It is therefore estimated that the productivity losses for the year 2004 amounted to $1.012 billion.

A combination of the smoking-related direct health care costs and the smoking-related productivity losses gives a clear picture of the enormous economic toll of tobacco in West Virginia. For the year 2004, this amounted to $1.858 billion using Model 1 and $2.076 billion using Model 2. Figure 7 compares these calculated combined costs per adult residents versus adult smokers in the state. These total costs, however, do not include the costs of productivity losses due to morbidity from smoking-related illness, nor do they include the costs of health care or productivity losses due to smokeless tobacco, cigars, pipes, and secondhand smoke.

Table 4 presents a county breakdown of the health impact of smoking in the state, i.e., estimated average annual smoking-related mortality from 1999-2003, as well as health care costs as calculated using both economic models. Figure 8 illustrates per capita smoking-attributable health care costs by county for 2004 generated using Model 2 SAFs and average annual deaths from 1999-2003. These costs range from a high of $893 in McDowell County to a low of $320 in Monongalia County. Figure 9 shows estimated smoking-attributable health care costs for 1998, with projected costs for 1999 through 2004. Medical inflation was used to project 1999 - 2004 costs for Model 1, while Consumer Price Index inflation was used for Model 2. Application of a relative error of 34 percent to Model 2 produces a range of expenditures from $703 million to $1.4 billion for 2004. Smoking-attributable medical costs calculated using both models fall within this range for all years.

Table 4 Health Impact of Smoking in West Virginia
County	Estimated Deaths Due to Smoking 1999-2003 Age 35+	2001 Estimated Population	Health Care Cost Model 1*		Health Care Cost Model 2**		Rank (Based on Model 2)
			Economic Costs (Distributed by Deaths)	Cost Per Capita	Economic Costs (Distributed by Deaths)	Cost Per Capita
Barbour	32	15,445	$6,958,975	$451	$8,752,187	$567	36
Berkeley	136	78,719	$29,861,933	$379	$37,556,851	$477	48
Boone	69	25,501	$15,151,187	$594	$19,055,394	$747	4
Braxton	32	14,763	$7,003,020	$474	$8,807,580	$597	26
Brooke	59	25,194	$12,904,935	$512	$16,230,321	$644	17
Cabell	224	95,829	$49,373,490	$515	$62,096,210	$648	16
Calhoun	19	7,419	$4,184,194	$564	$5,262,391	$709	6
Clay	26	10,296	$5,725,739	$556	$7,201,166	$699	7
Doddridge	16	7,458	$3,523,532	$472	$4,431,487	$594	27
Fayette	114	47,226	$25,105,165	$532	$31,574,344	$669	11
Gilmer	15	7,119	$3,347,355	$470	$4,209,913	$591	28
Grant	19	11,349	$4,272,282	$376	$5,373,178	$473	49
Greenbrier	74	34,444	$16,340,379	$474	$20,551,020	$597	25
Hampshire	34	20,674	$7,575,594	$366	$9,527,697	$461	50
Hancock	62	32,303	$13,697,730	$424	$17,727,405	$533	42
Hardy	25	12,809	$5,417,430	$423	$6,813,411	$532	43
Harrison	184	68,061	$40,476,572	$595	$50,906,706	$748	3
Jackson	63	28,057	$13,785,818	$491	$17,338,192	$618	22
Jefferson	67	43,448	$14,842,878	$342	$18,667,638	$430	52
Kanawha	467	197,766	$102,887,130	$520	$129,399,417	$654	14
Lewis	42	16,926	$9,161,183	$541	$11,521,866	$681	10
Lincoln	57	22,181	$12,596,626	$568	$15,842,566	$714	5
Logan	93	36,897	$20,436,485	$554	$25,702,624	$697	9
McDowell	86	26,561	$18,850,895	$710	$23,708,455	$893	1
Marion	142	56,267	$31,271,345	$556	$39,329,446	$699	8
Marshall	71	35,303	$15,591,628	$442	$19,609,329	$555	37
Mason	54	26,080	$11,891,920	$456	$14,956,268	$573	34
Mercer	149	62,022	$32,812,890	$529	$41,268,222	$665	13
Mineral	48	27,038	$10,614,640	$393	$13,349,854	$494	46
Mingo	75	27,578	$16,428,467	$596	$20,661,808	$749	2
Monongalia	95	82,320	$20,965,015	$255	$26,367,347	$320	55
Monroe	25	13,258	$5,549,563	$419	$6,979,592	$526	44
Morgan	30	15,232	$6,606,622	$434	$8,309,038	$545	41
Nicholas	55	26,322	$12,112,141	$460	$15,233,236	$579	32
Ohio	110	46,665	$24,136,193	$517	$30,355,685	$651	15
Pendleton	12	8,073	$2,730,737	$338	$3,434,402	$425	53
Pleasants	18	7,540	$4,008,017	$532	$5,040,816	$669	12
Pocahontas	19	8,942	$4,096,106	$458	$5,151,603	$576	33
Preston	51	29,309	$11,143,170	$380	$14,014,577	$478	47
Putnam	78	51,730	$17,265,306	$334	$21,714,286	$420	54
Raleigh	162	78,546	$35,719,804	$455	$44,924,198	$572	35
Randolph	44	28,273	$9,689,713	$343	$12,186,589	$431	51
Ritchie	24	10,351	$5,197,209	$502	$6,536,443	$631	19
Roane	33	15,461	$7,267,284	$470	$9,139,942	$591	29
Summers	32	14,224	$7,047,064	$495	$8,862,974	$623	21
Taylor	32	16,109	$7,047,064	$437	$8,862,974	$550	40
Tucker	16	7,219	$3,435,444	$476	$4,320,700	$599	24
Tyler	21	9,529	$4,580,591	$481	$5,760,933	$605	23
Upshur	44	23,358	$9,601,624	$411	$12,075,802	$517	45
Wayne	90	42,778	$19,819,867	$463	$24,927,114	$583	31
Webster	20	9,681	$4,492,503	$464	$5,650,146	$584	30
Wetzel	40	17,314	$8,808,830	$509	$11,078,717	$640	18
Wirt	13	5,889	$2,950,958	$501	$3,711,370	$630	20
Wood	175	87,742	$38,582,674	$440	$48,524,781	$553	38
Wyoming	50	25,226	$11,055,081	$438	$13,903,790	$551	39
Total WV	3,842	1,801,824	$846,000,000	$470	$1,064,000,000	$591
Note: * Model 1 uses smoking-attributable fractions (SAF's) calculated by Vincent Miller **Model 2 uses SAF's calculated by Leonard Miller

Footnotes:
 ³Bureau of Labor Statistics. United States Department of Labor. Employment Cost trends data. Available at http://data.bls.gov/cgi-bin/surveymost?ec
 ⁴

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