Medical expenditures of men with hypertension and/or a smoking habit: a 10-year follow-up study of National Health Insurance in Shiga, Japan

Abstract

Hypertension and smoking are major causes of disability and death, especially in the Asia-Pacific region, where there is a high prevalence of a combination of these two risk factors. We attempted to measure the medical expenditures of a Japanese male population with hypertension and/or a smoking habit over a 10-year period of follow-up. A cohort study was conducted that investigated the medical expenditures due to a smoking habit and/or hypertension during the decade of the 1990s using existing data on physical status and medical expenditures. The participants included 1708 community-dwelling Japanese men, aged 40-69 years, who were classified into the following four categories: 'neither smoking habit nor hypertension', 'smoking habit alone', 'hypertension alone' or 'both smoking habit and hypertension.' Hypertension was defined as a systolic blood pressure of X140 mm Hg, a diastolic blood pressure of X90 mm Hg or taking antihypertensive medications. In the study cohort, 24.9% had both a smoking habit and hypertension. During the 10-year follow-up period, participants with a smoking habit alone (18 444 Japanese yen per month), those with hypertension alone (21 252 yen per month) and those with both a smoking habit and hypertension (31 037 yen per month) had increased personal medical expenditures compared with those without a smoking habit and hypertension (17 418 yen per month). Similar differences were observed even after adjustment for other confounding factors (Po0.01). Japanese men with both a smoking habit and hypertension incurred higher medical expenditures compared with those without a smoking habit, hypertension or their combination.

Nicotine Dependence and Cost-Effectiveness of Individualized Support for Smoking Cessation: Evidence from Practice at a Worksite in Japan

“…In Japan, where the rate of smoking in males exceeds that of males in developed Western countries [4], [5], 38.6% of cancer-related deaths, 23.4% of deaths due to respiratory tract disease, and 23.0% of deaths due to cardiovascular disease among Japanese males have been attributed to a history of smoking [2]. Smoking is burdensome because of the effects on premature disability and excess mortality [2], [3] and also because of the substantial costs to medical insurers in Japan [6], [7]. Izumi et al [6] showed that over a follow-up period of 30 months, Japanese males with a history of smoking incurred medical costs averaging ¥3,000 per month in excess of the costs attributed to individuals who had never smoked.…”

Hypertension and medical expenditure in the Japanese population: Review of prospective studies

“…This comparison was made because of the fact that a very small percent- Analysis of covariance was used to compare logtransformed monthly medical expenditure in each blood pressure category, after adjustment for age, body mass index, drinking habit, serum total cholesterol, and a history of diabetes. From Nakamura et al [8] .…”

“…Although we manually searched for extra relevant articles in the reference lists of the identified articles and other publications, no additional relevant article was identified from these sources. Of the six relevant articles, three articles were from the same cohort study, but each dealt with different topics without duplicate publication [6][7][8] . The remaining three articles were all different [9][10][11] .…”

“…The Shiga NHI cohort study [8] examined the relationship between the combination of hypertension status and smoking status and subsequent medical expenditure in 1708 male participants after excluding male ex-smokers and all females, as smoking is more prevalent in Japanese men than in Japanese women [17] . Mean medical expenditure per month over a 10-year follow-up period was compared in the following four categories: "neither hypertively.…”

Smoking wears away happiness: New concept, ‘Smoking creates thunderclouds’

“…In the Japanese male population, hypertensive individuals with a smoking habit were reported to incur higher medical expenditures than individuals with a smoking habit alone, hypertension alone, or neither. 5 Over 50 years ago, lung cancer was reported to be caused by smoking, and since then, many diseases have been reported to be caused by smoking and involuntary exposure to cigarette smoke. In particular, chronic kidney disease is a growing worldwide problem that has increasingly been shown to be interwoven with CVD and smoking.…”