Health care expenses in relation to obesity and smoking among U.S. adults by gender, race/ethnicity, and age group: 1998-2011

Objectives: Obesity and smoking are two leading health risk factors and consume substantial health care resources. This study estimates and tracks annual per-capita health care expenses associated with obesity and smoking among U.S. adults aged 18 years and older from 1998 to 2011. Study design: Retrospective data analysis. Methods: Individual-level data came from the National Health Interview Survey 1996-2010 waves and the Medical Expenditure Panel Survey 1998-2011 waves. Annual per-capita health care expenses associated with obesity and smoking were estimated in two-part models, accounting for individual characteristics and sampling design. Results: Obesity and smoking were associated with an increase in annual per-capita total health care expenses (2011 US$) by $1360 (95% confidence interval: $1134-$1587) and $1046 ($846-$1247), out-of-pocket expenses by $143 ($110-$176) and $70 ($37-$104), hospital inpatient expenses by $406 ($283-$529) and $405 ($291-$519), hospital outpatient expenses by $164 ($119-$210) and $95 ($52-$138), office-based medical provider service expenses by $219 ($157-$280) and $117 ($62-$172), emergency room service expenses by $45 ($28-$63) and $57 ($44-$71), and prescription expenses by $439 ($382-$496) and $251 ($199-$302), respectively. From 1998 to 2011, the estimated per-capita expenses associated with obesity and smoking increased by 25% and 30% for total health care, 41% and 48% for office-based medical provider services, 59% and 66% for emergency room services, and 62% and 70% for prescriptions but decreased by 16% and 15% for out-of-pocket health care expenses, 3% and 0.3% for inpatient care, and 6% and 2% for outpatient care, respectively. Health care expenses associated with obesity and smoking were considerably larger among women, Non-Hispanic whites, and older adults compared with their male, racial/ethnic minority, and younger counterparts. Conclusions: Health care costs associated with obesity and smoking are substantial and increased noticeably during 1998-2011. They also vary significantly across gender, race/ethnicity and age.