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NGHIÊN CỨU GÁNH NẶNG KINH TẾ XÃ HỘI ĐỐI VỚI PHƠI NHIỄM THUỐC LÁ CHỦ YẾU VỀ BỆNH TIM MẠCH Ở VÙNG NÔNG THÔN_TÂY NAM TRUNG QUỐCThe economic burden of tobacco exposurerelate major cadiovascular diseases in rural SouthWest ChinaBệnh tim mạch (CVD) là một vấn đề y tế công cộng quan trong trên thế giới hiên tại. Ước tính gây nên một nửa số ca tủ vong do bệnh không lây nhiễm.Hút thuốc lá là một yếu tố nguy cơ độc lập gây nên bệnh tim mạch; Hút thuốc thụ động (SHS) cũng được nhiều nghiên cứu chứng minh là yếu tố gây nên CVD.
The economic burden of tobacco exposure-related major cardiovascular diseases in rural south- west China Cai Le, MD, Ph.D Professor School of Public Health Kunming Medical University Outline Background Objective Methodology Results Conclusions Background Cardiovascular diseases (CVD) are a major public health concern in the world, accounting for half of all non-communicable disease deaths worldwide China is also experiencing an epidemic of CVD during recent decades Smoking was an independent risk factor for CVD, and secondhand smoke (SHS) is also d emonstrated to be an established cause of C VD in previous studies Background As one of the most costly diseases, CVD represents a major economic burden on healthcare systems However, the literature on the economic consequences of CVD associated with tobacco use is still sparse in China Objectives The aim of this study is to use a prevalencebased, disease-specific cost-of-illness method to estimate the economic burden of two major components of CVD (coronary heart disease and stroke) attributable to both smoking and exposure to SHS in rural southwest China including direct and indirect costs Methodology Study area and population This study was a community-based, cross-sectional survey conducted in four rural areas of Yunnan province, China Yunnan is located in southwest China and had a recorded population of 45.9 million people Yunnan is a production and consumption hub for tobacco products, tobacco is cultivated in 45 of the province’s counties and more than 2.3 million farmers in the province are engaged in tobacco cultivation Cost components The cost of CVD comprised two components: direct costs and indirect costs Direct costs were further divided into two subcategories: direct medical costs and direct non-medical costs Data source Information regarding the prevalence, economic consequences and related aspects of CHD and stroke, smoking habits, and exposure to SHS in rural areas of Yunnan province were obtained from a communitybased cross-sectional health interview and examination survey Sampling technique A multi-stage stratified random sampling method was used to select individuals aged ≥18 years from a total of 44 townships in Yunnan province Calculation of Population Attributable Fraction (PAF) P (OR 1) PAF 100% P (OR 1) Where: P denotes to the prevalence of smoking or exposure to SHS in a given population, and OR denotes odds ratio for disease-specific morbidity caused by smoking or exposure to SHS Calculation of direct costs The costs associated with outpatient/inpatient visits were estimated by multiplying the number of outpatient visits/inpatient hospital admissions related to CVD by the outpatient/inpatient unit costs per year Calculation of indirect costs Indirect costs were estimated as the earnings lost as a result of CVD-related morbidity using the “human capital” approach Statistical analysis Descriptive analysis techniques and multivariate logistic regression were used in this study All data analyses were conducted with R2.9.2 software Results Demographic characteristics of the study population A total of 18,000 individuals aged ≥18 years were asked to participate in this study Of these, 17,158 agreed to participate (response rate = 95.3%) Participants in the study included 8,156 males and 9,002 females Prevalence of smoking, SHS , and CVD The overall prevalence of smoking and exposure to SHS in the study population was 35.5% and 42.2, respectively The overall prevalence of stroke and CHD was 1.0% and 1.7% among the surveyed population, respectively OR and PAF% of major cardiovascular diseases associated with smoking and SHS Secondhand smoke exposure (SHS) Smoking Variables Multivariable adjusted OR † (95% CI) PAF(%) Multivariable adjusted OR † (95% CI) PAF(%) Male 2.42** (1.28, 4.58) 50.93 2.32** (1.26, 4.25) 33.98 Female 4.01* (1.38, 11.68) 3.77 1.92** (1.18, 3.11) 28.39 All 2.46** (1.67, 3.64) 34.14 2.04** (1.39, 2.97) 30.50 Male 8.32** (3.88, 17.87) 84.25 3.54** (2.14, 5.87) 49.76 Female 4.27** (1.85, 9.84) 4.08 1.60** (1.14, 2.23) 20.55 All 5.34** (3.15, 9.03) 60.64 1.94** (1.45, 2.59) 28.40 Stroke CHD OR and PAF% of major cardiovascular diseases associated with smoking and SHS There were significant positive associations between smoking, exposure to SHS and risk for stroke and CVD for both sexes Cost of illness of major cardiovascular diseases (in US$) in rural southwest China Stroke Coronary heart disease Unit cost Total (million) Unit cost Male Female All Total (million ) Direct medical costs 1238.0 1565.0 1406.8 8.71 2324.6 1331.7 1738.0 16.16 Outpatient visits 13.70 35.6 26.2 0.16 42.3 30.62 34.5 0.32 Hospitalization 1048.3 1292.0 1171.9 7.26 1928.4 1052.5 1415.2 13.16 Self-medication 176.04 237.42 208.7 1.29 353.8 248.6 288.3 2.68 Direct non-medical costs 19.43 102.21 60.03 0.37 31.9 59.3 48.6 0.45 Total direct costs 1257.4 1667.2 1466.8 9.08 2356.5 1391.1 1786.6 16.61 9.82 23.12 19.3 0.12 14.5 39.1 31.2 0.29 1267.2 1690.4 1486.2 9.2 2371.0 1430.2 1817.9 16.9 Cost components Total indirect costs Total cost of illness Male Femal e All Cost of illness of major cardiovascular diseases (in US$) in rural southwest China Males had higher unit costs of illness due to CHD than females, whereas unit costs of illness due to stroke were higher in females than in males (P