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Abstract
Background In 2023, President Biden issued an executive order requiring cost-benefit analyses for new regulations to account for distributional effects. To inform new tobacco regulations, we estimate for the first time racial and ethnic disparities in spending and outcomes associated with smoking.
Methods With the 2008–2019 Medical Expenditure Panel Survey linked to the National Health Interview Survey, n=118 084 adults-years, logit models estimate the per cent of the top 10 health conditions attributable to smoking. Two-part regression models estimate the share of and total annual healthcare spending attributable to smoking.
Results White adults had higher ever-smoked rates, but minority smoking adults had twice as much of their annual medical spending associated with smoking than white smoking adults, 25% vs 12% (p<0.01). minority adults who smoked had 41% (p<0.05) higher risks of multiple chronic conditions associated with smoking than white adults. While the share of white smoking adults trying to quit declined to 53% in 2019, this desire increased to 63% for minorities. From 2008–2016, smoking comprised 7.5% of the nation’s spending for white adults and 10.7% for minorities (p<0.05). In 2017–2019, this declined to 2.5% of the nation’s spending for white adults and 8.9% for minorities (p<0.05). For any new antitobacco regulation, the cost savings would be $134 million per year for every 100 000 minorities averted from initiating smoking, 135% more than the $57 million saved annually for 100 000 white adults averted.
Implications Minority adults may benefit substantially more from antitobacco regulations and past federal cost-benefit analyses would have overlooked this.
- Economics
- Health Services
- Disparities
Data availability statement
Data may be obtained from a third party and are not publicly available. The MEPS-NHIS linked data are confidential federal data available to the public but require a project proposal to be approved by the CDC.
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Data availability statement
Data may be obtained from a third party and are not publicly available. The MEPS-NHIS linked data are confidential federal data available to the public but require a project proposal to be approved by the CDC.
Footnotes
Contributors WE had full access to, verified all the data in the study, and takes responsibility for the integrity of the data and the accuracy of the data analysis. RBV controlled the decision to publish and takes full responsibility for the work. Conceptualisation: WE and RBV. Data curation: WE. Supervision: RBV. Methodology: WE and RBV. Statistical analysis and programming: WE. Visualisation: WE and RBV. Writing (first draft): WE and RBV. Writing (review and editing): WE and RBV. WE is the guarantor.
Funding AHRQ
Disclaimer The views expressed in this article are those of the authors, and no official endorsement by the US Department of Health and Human Services or the AHRQ is intended or should be inferred.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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