Burden of smoking on disease-specific mortality, DALYs, costs: the case of a high-income European country

Abstract

Background: Smoking is a major risk factor for chronic diseases causing early death and disability. Smoking prevalence over the past 25years has remained high in Switzerland. Evidence about the burden of disease and cost of illness attributable to smoking can support tobacco control. The aim of the present paper is to quantify from a societal perspective the mortality, disability-adjusted life years (DALYs), medical costs and productivity losses attributable to smoking in Switzerland in 2017.

Methods: Smoking attributable fractions (SAFs) were calculated based on the prevalence of current and former active smoking in the latest Swiss Health Survey from 2017 and relative risks from the literature. The SAFs were then multiplied with the number of deaths, DALYs, medical costs and productivity losses in the total population.

Results: In the Swiss population in 2017 smoking accounted for 14.4% of all deaths, for 29.2% of the deaths due to smoking-related diseases, 36.0% of the DALYs, 27.8% of the medical costs and 27.9% of productivity losses. Total costs amounted to CHF 5.0 billion which equals CHF 604 per capita per year. The highest disease burden in terms of mortality and DALYs attributable to smoking was observed for lung cancer and chronic obstructive pulmonary disease (COPD), whereas the highest cost of illness in terms of medical costs was observed for coronary heart diseases and lung cancer and in terms of productivity losses for COPD and coronary heart diseases. Sex and age group differences were found.

Conclusions: We provide an estimate of the burden of smoking on disease-specific mortality, DALYs, medical costs and productivity losses in Switzerland that could be prevented through evidence-based tobacco prevention and control policies as well as regular monitoring of tobacco consumption.

Keywords: Burden of disease; Chronic disease; Cost of illness; Smoking.

Fig. 1

Overview of study design The burden of disease in the total population was extracted from specific data sources. Smoking related diseases were based on literature (1). The relative risks of these diseases were extracted from the General Surgeon Report 2014 (2) and combined with the prevalence of current, former and never smokers acquired from the latest Swiss Health Survey (3) for the calculation of the smoking attributable fractions (SAFs) (4). In the last step, SAFs were multiplied with mortality, disability-adjusted life years (DALYs), medical costs and productivity losses in the total population (5) to get to the burden attributable to smoking (6).