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Economic burden of smoking: evidence from a 1.6 million cohort in Hong Kong.

Chen T., Wang B., Lee MH., Chan KH., Chan SSC., Li X., Chui SLC., Lai FTT., Chan EWY., Wong ICK., Wan EYF.

BackgroundDeclining in smoking prevalence may not correlate with reduced economic burden. This study aimed to estimate Hong Kong's economic burden of smoking using actual territory-wide public healthcare expenditure data.MethodsThis retrospective cohort study included adult public healthcare service users in the Hong Kong Hospital Authority healthcare system, with recorded smoking status between 1 January 2008 and 31 December 2012, and follow-up until 31 December 2022. Participants were classified into never-smokers, ex-smokers or current smokers. Outcomes were costs associated with general and specialist outpatient clinics (GOPC, SOPC), accident and emergency services (A&E), and hospitalization. A generalized linear model with log link function and fine stratification weighting evaluated differences in annual average costs per person for each healthcare service.ResultsAmong the 1,571,065 individuals analyzed, 14.3% were current smokers, 11.9% ex-smokers, and 73.8% never-smokers. Smoking was associated with significantly higher annual average costs per person for SOPC, A&E, and hospitalization. Current smokers, compared to never-smokers, had a relative risk of 1.19 for SOPC, 1.40 for A&E, and 1.57 for hospitalization. Sex-specific analyses showed higher cost multipliers for women than men for SOPC, A&E and hospitalization. Additional annual cost of overall public healthcare services associated with smoking was projected at USD725.66 and USD336.30 million for current smokers and ex-smokers, respectively, accounting for 0.27% of Hong Kong's GDP and 7.46% of total healthcare expenditures in 2023.ConclusionsSmoking imposes substantial economic burdens in Hong Kong despite its low smoking prevalence. Accurate estimation of this burden is critical for advancing tobacco control measures.

More information Original publication

DOI

10.1016/j.amjmed.2026.03.034

Type

Journal article

Publication Date

2026-04-01T00:00:00+00:00

Addresses

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