Deaths from smoking and from HIV/AIDS among gay and bisexual men in California, 2005-2050.

INTRODUCTION: Deaths from HIV/AIDS have long been of concern to the gay community, but less attention has focused on smoking-attributable deaths despite the relatively high smoking rates among gay and bisexual men. This study compared deaths from HIV/AIDS with smoking-attributable deaths among California gay and bisexual men from 2005 to 2050. METHODS: Smoking-attributable fractions (SAFs) were estimated using smoking prevalence for gay and bisexual men from the 2011-2014 California Health Interview Surveys and published relative risks of death. Smoking-attributable deaths were calculated by multiplying the SAFs by deaths among gay and bisexual men. Deaths from HIV/AIDS among men who have sex with men was obtained from the California Department of Public Health. Future deaths from smoking and HIV/AIDS were projected using regression equations based on time trends. RESULTS: From 2005 to 2014, smoking caused over 6800 deaths among gay and bisexual men, while nearly 9500 died from HIV/AIDS. Mortality from both causes has been falling, but deaths from HIV/AIDS have been falling more rapidly. Projections suggest that in the mid-2040s, more gay/bisexual men will die from smoking than from HIV/AIDS. CONCLUSION: Smoking will surpass HIV/AIDS as a cause of death among gay and bisexual men in California within a few decades. The lesbian, gay, bisexual and transgender (LGBT) community was highly effective in drawing attention and resources to the fight against HIV/AIDS, saving untold lives by hastening effective treatments. Lessons learnt in the fight against AIDS should be used to help fight the tobacco epidemic.

Sexual Identity Disparities in Smoking and Secondhand Smoke Exposure in California: 2003-2013.

OBJECTIVES: To determine smoking prevalence, smoking behavior, and secondhand smoke (SHS) exposure of lesbian, gay, and bisexual (LGB)-identified Californians; compare these with that of heterosexuals; and analyze changes over time. METHODS: We analyzed self-reported variables from 111 965 heterosexual, 1667 lesbian, and 1706 bisexual women, and 79 881 heterosexual, 2505 gay, and 911 bisexual men, aged 18 to 70 years, in the 2003-2013 California Health Interview Surveys. RESULTS: Sexual minority women had higher smoking prevalence, and female bisexual smokers were less likely to be light smokers, than heterosexuals. Smoking prevalence was higher among sexual minority men, and gay smokers were more likely to be daily smokers than were heterosexuals; and male bisexual smokers were more likely to be light smokers than were gay or heterosexual smokers. Sexual minority adults were more likely to have SHS exposure at home than were heterosexuals. Current smoking prevalence decreased annually 4% and 7% for lesbian and bisexual women, and 5% and 6% for gay and bisexual men, respectively. Exposure to SHS fell an average of 11% annually for sexual minority men and women. CONCLUSIONS: Sexual identity disparities in smoking and SHS exposure exist in California, with bisexuals particularly at risk.

The Cost of Smoking in California.

INTRODUCTION: The economic impact of smoking, including healthcare costs and the value of lost productivity due to illness and mortality, was estimated for California for 2009. METHODS: Smoking-attributable healthcare costs were estimated using a series of econometric models that estimate expenditures for hospital care, ambulatory care, prescriptions, home health care, and nursing home care. Lost productivity due to illness was estimated using an econometric model predicting how smoking status affects the number of days lost from work or other activities. The value of lives lost from premature mortality due to smoking was estimated using an epidemiological approach. RESULTS: Almost 4 million Californians still smoke, including 146 000 adolescents. The cost of smoking in 2009 totaled $18.1 billion, including $9.8 billion in healthcare costs, $1.4 billion in lost productivity from illness, and $6.8 billion in lost productivity from premature mortality. This amounts to $487 per California resident and $4603 per smoker. Costs were greater for men than for women. Hospital costs comprised 44% of healthcare costs. CONCLUSIONS: Despite extensive efforts at tobacco control in California, healthcare and lost productivity costs attributable to smoking remain high. Compared to costs for 1999, the total cost was 15% greater in 2009. However, after adjusting for inflation, real costs have fallen by 13% over the past decade, indicating that efforts have been successful in reducing the economic burden of smoking in the state.

Smoking-Attributable Doctor Visits and Emergency Room Utilization and Costs by California's Lesbian, Gay, and Bisexual Community.

The lesbian, gay, and bisexual (LGB) community is known to smoke at greater rates than the general population, but there has been no study estimating the impact of cigarette smoking on healthcare utilization and costs in the LGB population. Using data from the 2005-2014 California Health Interview Surveys, we determine smoking-attributable healthcare utilization and costs among California's LGB-identified community. Our findings indicate that lesbian/bisexual women who smoke incur excess doctor visits and emergency room visits compared to their never smoking counterparts. No statistically significant differences were found for gay/bisexual men. Annual smoking-attributable costs were $58.3 million for the California LGB community (2019 dollars).

The cost of smoking for California's Hispanic community.

INTRODUCTION: The economic impact of smoking for California's Hispanic population for 2002 was estimated. The estimates include smoking-attributable health care expenditures and productivity losses from smoking-caused mortality. METHODS: Smoking-attributable health care expenditures for Hispanics were estimated using a series of econometric models for four types of expenditures: ambulatory care, drugs, inpatient care, and home health care. Models were estimated using national survey data. The estimated parameters were then applied to California-specific data. Smoking-attributable mortality was assessed using epidemiological models. Three measures of mortality were estimated: deaths, years of potential life lost, and the value of lost productivity. RESULTS: Adult current smoking prevalence for Hispanics was 13.1% compared to 15.4% for all Californians in 2002. Male Hispanics smoke at much higher rates than females (18.7% vs. 7.2%), and one in four smokers in the state is Hispanic. The health care cost of smoking was $662 million for the Hispanic community. A total of 3,003 Hispanic Californians died of smoking-attributable illness in 2002, representing a loss of nearly 44,000 years of life and $711 million in productivity. The total cost of smoking for this community amounted to $1.4 billion (2002 dollars) or $1.9 billion expressed in 2010 dollars. CONCLUSIONS: Smoking prevalence is relatively low among California Hispanics, but the economic impact is large because the population is large. Tobacco control programs should focus on helping Hispanic men who smoke to quit, maintaining low smoking prevalence among Hispanic women, and should be culturally tailored to specific Hispanic subpopulations with higher smoking rates.

The disproportionate cost of smoking for African Americans in California.

OBJECTIVES: We estimated the economic impact of smoking on African Americans in California in 2002, including smoking-attributable health care expenditures and productivity losses from smoking-caused mortality. METHODS: We estimated econometric models of smoking-attributable ambulatory care, prescription drugs, inpatient care, and home health care using national and state survey data. We assessed smoking-attributable mortality using epidemiological models. RESULTS: Adult smoking prevalence for African Americans was 19.3% compared with 15.4% for all Californians. The health care cost of smoking was $626 million for the African American community. A total of 3013 African American Californians died of smoking-attributable illness in 2002, representing a loss of over 49,000 years of life and $784 million in productivity. The total cost of smoking for this community amounted to $1.4 billion, or $1.8 billion expressed in 2008 dollars. CONCLUSIONS: Although African Americans account for 6% of the California adult population, they account for over 8% of smoking-attributable expenditures and fully 13% of smoking-attributable mortality costs. Our findings confirm the need to tailor tobacco control programs to African Americans to mitigate the disproportionate burden of smoking for this community.

The economic burden of breast cancer in California.

This paper estimates the healthcare costs and the value of lost productivity from premature deaths for California women with breast cancer in 2001, with an updated estimate for 2008. Multiple secondary data sources were used to estimate the healthcare cost of breast cancer. Mortality costs were estimated as the product of the number of deaths and the expected value of a woman's future earnings. The total economic cost of breast cancer in California was $1.43 billion in 2001, or $1.91 billion in 2008 dollars. Breast cancer is costly both in terms of healthcare dollars and the value of lost lives. Regular screening and access to treatment for all women will allow the disease to be diagnosed earlier, the prognosis improved, and the economic burden reduced.