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The healthcare costs of secondhand smoke exposure in rural China
  1. Tingting Yao1,2,
  2. Hai-Yen Sung1,
  3. Zhengzhong Mao3,
  4. Teh-wei Hu4,5,
  5. Wendy Max1
  1. 1Institute for Health & Aging, University of California, San Francisco, California, USA
  2. 2Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
  3. 3Huaxi School of Public Health, Sichuan University, Chengdu, China
  4. 4Center for International Tobacco Control, Public Health Institute, Oakland, California, USA
  5. 5School of Public Health, University of California, Berkeley, California, USA
  1. Correspondence to Dr Tingting Yao, Institute for Health & Aging, University of California, San Francisco, 3333 California Street, Suite 340, San Francisco, CA 94118, USA; tingting.yao{at}


Objective The goal of this study was to assess the healthcare costs attributable to secondhand smoke (SHS) exposure among non-smoking adults (age ≥19) in rural China.

Methods We analysed data from the 2011 National Rural Household Survey which was conducted among adults in five provinces and one municipality in China (N=12 397). Respondents reported their smoking status, health conditions and healthcare expenditures. Relative risks were obtained from published sources. Healthcare costs included annual outpatient and inpatient hospitalisation expenditures for five SHS-related diseases: asthma, breast cancer (female only), heart disease, lung cancer and tuberculosis. SHS-attributable healthcare costs were estimated using a prevalence-based annual cost approach.

Findings The total healthcare costs of SHS exposure in rural China amounted to $1.2 billion in 2011, including $559 million for outpatient visits and $612.4 million for inpatient hospitalisations. The healthcare costs for women and men were $877.1 million and $294.3 million, respectively. Heart disease was the most costly condition for both women ($701.7 million) and men ($180.6 million). The total healthcare costs of SHS exposure in rural China accounted to 0.3% of China's national healthcare expenditures in 2011. Over one-fifth of the total healthcare costs of SHS exposure in rural China were paid by health insurance. The out-of-pocket expenditures per person accounted for almost half (47%) of their daily income.

Conclusions The adverse health effects of SHS exposure result in a large economic burden in China. Tobacco control policies that reduce SHS exposure could have an impact on reducing healthcare costs in China.

  • Economics
  • Global health
  • Low/Middle income country
  • Public policy
  • Secondhand smoke

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