Abstract
Purpose
To describe the development of a model for estimating the effects of tobacco use upon Quality Adjusted Life Years (QALYs) and to estimate the impact of tobacco use on health outcomes for the United States (US) population using the model.
Method
We obtained estimates of tobacco consumption from 6 years of the National Health Interview Survey (NHIS). In addition, NHIS data were used to impute the Quality of Well-Being (QWB) Scale using a new methodology known as QWBX1. The QWB places health status on a continuum ranging from death (0.0) to full functioning without symptoms (1.0). The method allows the adjustment of life expectancy for reduced quality of life associated with health conditions. NHIS data were matched to the National Death Index for 14,464 deaths occurring by December 31, 1997. The analysis is limited to adults between the ages of 18 and 70 years.
Results
Quality of Well-Being scores were broken down by age and for six smoking categories: (1) non-smokers, (2) those who smoke 1–10 cigarettes per day, (3) 11–20 cigarettes per day, (4) 21–30 cigarettes per day, and (5) 31–40 cigarettes per day, and (6) 40 or greater cigarettes per day. There was a systematic relationship between current tobacco use and health-related quality of life at each point along the age spectrum and there was a clear and systematic separation of quality-adjusted life expectancy by number of cigarettes smoked per day. Teenagers who continue to smoke loose 3.5 QALYs between ages 18 and 70 in comparison to non-smokers. A greater portion in the loss in QALE is attributable to quality of life than to shorten life expectancy.
Conclusions
The overall goal of Healthy People 2010 is to increase Years of Healthy Life (or QALE) in the United States. Each year, tobacco use results in hundreds of thousands of quality-adjusted life years lost. Combined models of morbidity and mortality incorporating a range of tobacco consumption levels are required to best represent the impact of tobacco use.
Similar content being viewed by others
References
Adams P.F. and Benson V. (1990). Current estimates from the National Health interview survey, 1989. Vital Health Statistics 10(176): 1–221
Anderson J.P (2001). Activity limitations reported in the National Health Interview Survey: An anomaly and its effect on estimates of national well-being. American Journal of Public Health 91(7): 1135–1136
Anderson J.P., Bush J.W., Chen M. and Dolenc D. (1986). Policy space areas and properties of benefit-cost/utility analysis. Journal of the American Medical Association 255(6): 794–795
Anderson J.P. and Harris J.P. (2001). Impact of Meniere’s disease on quality of life. Otology and Neurotology 22(6): 888–894
Anderson J.P., Kaplan R.M., Berry C.C., Bush J.W. and Rumbaut R.G. (1989). Interday reliability of function assessment for a health status measure. The Quality of Well-Being scale. Medical Care 27(11): 1076–1083
Cromwell J., Bartosch W.J., Fiore M.C., Hasselblad V. and Baker T. (1997). Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Agency for Health Care Policy and Research [see comments]. Journal of the American Medical Association 278(21): 1759–1766
Gold M.R. (1996). Cost-effectiveness in Health and Medicine. Oxford University Press, New York
Graham J.D., Corso P.S., Morris J.M., Segui-Gomez M. and Weinstein M.C. (1998). Evaluating the cost-effectiveness of clinical and public health measures. Annual Review of Public Health 19(4): 125–152
Heller W.D., Scherer G., Sennewald E. and Adlkofer F. (1998). Misclassification of smoking in a follow-up population study in southern Germany. Journal of Clinical Epidemiology 51(3): 211–218
Holbrook T.L., Hoyt D.B. and Anderson J.P. (2001). The impact of major in-hospital complications on functional outcome and quality of life after trauma. Journal of Trauma 50(1): 91–95
‘Impact of smoking on life expectancy and disability’. 2001, Available at: http://www.statcan.ca/Daily/English/010622/d010622a.htm
Kaplan R., Ake C., Emery S. and Navarro A. (2001). Simulation of tobacco tax variation on population health in California. American Journal of Public Health 91(2): 1–6
Kaplan R.M., Alcaraz J.E., Anderson J.P. and Weisman M. (1996). Quality-adjusted life years lost to arthritis: effects of gender, race,and social class. Arthritis Care and Research 9(6): 473–482
Kaplan R.M., Bush J.W. and Berry C.C. (1976). Health status: Types of validity and the index of well-being. Health Services Research 11(4): 478–507
Kaplan R.M., Bush J.W. and Berry C.C. (1979). Health status index: Category rating versus magnitude estimation for measuring levels of well-being. Medical Care 17(5): 501–525
Kaplan R.M. and Erickson P. (2000). Gender differences in quality-adjusted survival using a Health-Utilities Index. American Journal of Preventive Medicine 18(1): 77–82
Kaplan R.M., Ganiats T.G., Sieber W.J. and Anderson J.P. (1998). The Quality of Well-Being Scale: Critical similarities and differences with SF-36 [see comments]. International Journal for Quality in Health Care 10(6): 509–520
Kovar M.G. (1989). Data systems of the National Center for Health Statistics. Vital Health Stat 1(23): 1–21
Malarcher A.M., Schulman J., Epstein L.A., Thun M.J., Mowery P. and Pierce B. (2000). Methodological issues in estimating smoking-attributable mortality in the United States. American Journal of Epidemiology 152(6): 573–584
Peto R., Lopez A., Boreham J., Thun M. and Heath C.J. (1994). Mortality from Smoking in Developed Countries 1950–2000: Indirect Estimates from National Vital Statistics. Oxford University Press, Oxford
Taylor, W.C., T.M. Pass, D.S. Shepard and A.L. Komaroff: 1987, ‘Cholesterol reduction and life expectancy’. A model incorporating multiple risk factors [published erratum appears in Ann Intern Med 1988 Feb, 108(2): 314]. Annals of Internal Medicine 106(4), pp. 605–614
Thun M.J., Apicella L.F. and S.J. Henley. (2000). Smoking vs other risk factors as the cause of smoking-attributable deaths: Confounding in the courtroom. Journal of the American Medical Association 284(6): 706–712
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by a Grant 11RT-0243 from the Californian Tobacco Related Disease Research Program (TRDRP)
Rights and permissions
About this article
Cite this article
Kaplan, R.M., Anderson, J.P. & Kaplan, C.M. Modeling Quality-Adjusted Life Expectancy Loss Resulting from Tobacco use in the United States. Soc Indic Res 81, 51–64 (2007). https://doi.org/10.1007/s11205-006-0014-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11205-006-0014-y