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An Economic Evaluation of the Medical Effects of Parental Smoking

C. Andrew Aligne, MD; Jeffrey J. Stoddard, MD

Arch Pediatr Adolesc Med. 1997;151(7):648-653.

Abstract
Objective
To determine the economic influence of pediatric disease attributable to parental smoking.

Data Sources
Computerized bibliographic databases were searched. Subject headings included asthma, burn, cost, low birth weight, otitis media, respiratory syncytial virus bronchiolitis, sudden infant death syndrome, and tobacco smoke pollution. The following constraints were applied to the published articles we studied: publication time, January 1980 through May 1996; age range of children studied, neonate to 18 years; and written in English. Articles used specifically as references for cost issues were limited to studies performed in the United States.

Data Extraction
This study is a literature synthesis, which uses as its primary source the results of previously published best estimates. This is not a metaanalysis of studies analyzing the relationships between childhood disease and smoking.

Results
Using data for relative risk, prevalence, and cost of illness and death, we calculated the attributable risk fraction and corresponding direct medical expenditures and costs for loss of life. Costs are adjusted to 1993 dollars. Estimated annual excess cases of childhood illness and death attributable to parental smoking include low birth weight (46 000 cases, 2800 perinatal deaths), sudden infant death syndrome (2000 deaths), respiratory syncytial virus bronchiolitis (22 000 hospitalizations, 1100 deaths), acute otitis media (3.4 million outpatient visits), otitis media with effusion (110000 tympanostomies), asthma (1.8 million outpatient visits, 14 deaths), and fire-related injuries (10 000 outpatient visits, 590 hospitalizations, and 250 deaths).

Conclusions
Parental smoking is an important preventable cause of morbidity and mortality among American children; it results in annual direct medical expenditures of $4.6 billion and loss of life costs of $8.2 billion. Additional efforts to reduce children's exposure to tobacco smoke are warranted.

Arch Pediatr Adolesc Med. 1997;151:648-653

Author Affiliations
Department of Pediatrics, University of Wisconsin Medical School, Madison. Dr Aligne is now with the Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY.

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