DALLAS, Aug. 19 -- Just a small annual percentage drop in the size of the nation's population of smokers quickly pays off with "substantial" health and economic benefits, a new analysis shows in today's American Heart Association journal Circulation.
A seven-year program that reduced smoking prevalence by only 1 percent per year would result in 63,840 fewer hospitalizations for heart attack and 34,261 fewer hospitalizations for stroke, resulting in a total savings of $3.2 billion in direct medical costs alone, California scientists calculate.
Such a program also would prevent about 13,100 deaths from heart attack that occur before people reach the hospital, say the researchers, who used California's showcase tobacco control program as the model for their analysis. That program began after the state's voters approved Proposition 99 in 1988 creating a tax-funded anti-tobacco education program.
Even a one-time, one-percent reduction in smoking prevalence brings sizable savings, with an estimated 924 heart attacks and 538 strokes avoided in the first year, resulting in an immediate savings of $44 million, the study shows. The University of California researchers conclude that these figures justify significant investment in programs designed to reduce adult smoking.
"In contrast to cancer and emphysema, the impact of smoking cessation accrues rapidly when heart disease and stroke are considered," James M. Lightwood, Ph.D., and Stanton A. Glantz, Ph.D., write in Circulation.
"When most people think about smoking, they think about cancer, and cancer risks associated with smoking take a long time to resolve," says Glantz, a prolific researcher on tobacco's effects on health who is professor of medicine in the department of cardiology and the Institute for Health Policy Studies at the University of California-San Francisco.
But heart disease is the main killer from smoking, Glantz notes. "And because the economic benefits from smoking cessation in reducing both heart disease and stroke come so quickly, programs designed to help people stop smoking will pay for themselves through the immediate health benefits and economic savings."
At the individual level, those savings appear to start modestly but rapidly grow to significant sums that should get the attention of political leaders and health providers, he says. Creating just one new non-smoker reduces anticipated medical costs associated with heart attack and stroke by $47 in the first year and by $853 during the next seven years, the researcher estimates. "If you're an HMO (health maintenance organization) or government insurer that is dealing with large numbers of people, the numbers add up and become quite big, quite fast."
Unlike earlier programs that focused on long-term, "global" costs of tobacco use, including lost wages, illness and death, the researchers this time "went in the opposite direction" -- looking only at short-term, out-of-pocket medical costs of caring for smokers.
Many insurance companies don't pay for smoking cessation, and preventing tobacco use is not high on the government's priority list, Gantz says.
The lesson from California is that monetary savings from preventing heart attacks and strokes alone "would basically pay for the program," says Glantz.
"And that's not counting the fact that you're preventing a lot of other diseases and improving the health of the population," he adds.
Glantz and co-author Lightwood, a research fellow at UCSF, based their conclusions on earlier population studies showing that the risk of heart disease and stroke decline rapidly over time due to smoking cessation. Then they developed statistical models incorporating health-care costs to calculate how the entire nation would benefit economically if the pace of smoking cessation nationally were accelerated to match that seen in California, where smoking prevalence has dropped by about 1 percent during each of the anti-tobacco program's first seven years.
In an editorial accompanying the Circulation report, William B. Kannel, M.D., of Boston University calls the new findings "a thoughtful analysis designed to encourage policy-makers to take appropriate action." He noted that in the Framingham (Mass.) Heart Study, cigarette smoking accounted for 55 percent of heart disease in a study of participants under age 55. "The preventive potential of smoking abatement in adult smokers to avoid coronary disease is huge."
The new study's perspective is especially worth heeding because it comes from Glantz, "who has devoted an entire career to combating the pernicious tobacco habit," Kannel notes. Glantz's book, The Cigarette Papers, analyzing 10,000 pages of previously secret tobacco industry documents, is credited with helping bring about current litigation against the industry.
Circulation is one of five journals published in Dallas by the American Heart Association.
Media advisory: Dr. Glantz can be reached in San Francisco at (415) 476-3893.
Reporters may call (214) 706-1396 for copies of his journal report. (Please do not publish telephone numbers.)