First-of-its-Kind Study Examines Disparities in Healthcare Costs and Outcomes of Cigarette Smoking in the United States

Findings inform distributional cost-benefit analyses for tobacco control policies and related research

In first-of-its-kind research to examine racial and ethnic disparities in the medical costs of smoking in the United States, the Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) found that adults from some racial and ethnic populations benefit substantially more than others from tobacco control policies. The research, published today in the journal Tobacco Control, supports President Joe Biden’s April 2023 Executive Order calling for policymakers to examine distributional effects in cost-benefit analyses required in the rulemaking process.  This study helps inform such analyses and will benefit other research in this area.

“It has been clear for decades now that smoking cigarettes has serious, deadly health effects. The federal government continues to work on encouraging people to quit, or not start using tobacco at all. However, this new study shows how much work there is still to do,” said HHS Secretary Xavier Becerra. “Some racial and ethnic populations pay disproportionally higher costs and experience worse health outcomes related to tobacco usage. HHS will continue to do its part to advance health equity and decrease disparities, including by providing policy makers with the tools that they need.”

“Minority communities have not reaped very much in medical cost-savings from the large reduction in smoking over the decades,” said AHRQ Director Dr. Robert Valdez, co-author of the study. “Our findings will help policymakers conduct cost-benefit analyses that accurately reflect the burden of healthcare costs and adverse outcomes of cigarette smoking on racial and ethnic communities.”

The study shows that even though adults in specific racial and ethnic populations have a lower ever-smoked rate than White adults and make more attempts to quit, their medical spending associated with smoking was twice as high, with a 41% higher rate of having multiple chronic conditions associated with smoking.

“Disparities in medical spending, as well as adverse health outcomes, are continuing to increase over time,” said AHRQ co-author Dr. William Encinosa. “AHRQ’s results indicate that racial and ethnic populations benefit substantially from tobacco control policies, such as tobacco product regulations.”

The article, “Racial and Ethnic Disparities in the Healthcare Costs and Outcomes of Smoking in the United States: 2008-2019,” is published in Tobacco Control and may be found at: https://tobaccocontrol.bmj.com/lookup/doi/10.1136/tc-2023-058136.