ArticleBMJ open2019
National medical expenditures by smoking status in American adults: an application of Manning's two-stage model to nationally representative data.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it, 6 citations in OpenAlex.
- Economic Burden of Self-Reported Tobacco Smoking Compared with Non-Smoking: Systematic Review and Meta-Analysis of Direct Health Care Costs.Advances in therapy · 2025Pooled it
- Impact of reducing nicotine in cigarettes on mortality, economic costs and major depression in the USA.Tobacco control · 2026Article
- Health, Equity, and Economic Impacts of a Nicotine Product Standard in the United States for People With and Without Major Depression.medRxiv : the preprint server for health sciences · 2025Article
- Comprehensive review of the national surveys that assess E-cigarette use domains among youth and adults in the United States.Lancet regional health. Americas · 2023Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 2 countries.
Funding
Abstract
objectivesTo assess the medical expenditures of American adults by their smoking status-Current, Former or Never smokers. We update these expenditures through 2015 controlling for personal characteristics and medical history and assess the impact of years-since-quitting and decade of life. SETTING AND
participantsWeighted sample of American adults, 2011-2015. The linked National Health Interview Survey (NHIS) and Medical Expenditure Panel Survey (MEPS) are annual weighted representations of approximately 250 million adults. Sampling of NHIS is multistage with data collected throughout the year. PRIMARY OUTCOME MEASURES: Using data from NHIS and MEPS, we collected demographic data, self-reported medical history and current smoking status. Smoking status was designated as Never, Current and Former, along with years-since-quitting. Total medical expenditures were collected from MEPS for 2011-2015. We used Manning's two-part model to estimate average expenditures per individual and marginal costs for individuals at all levels of smoking status.
resultsAmerican adults averaged US$4830 in average medical expenditures. Never smokers (US$4360, 95% CI 4154.3 to 4566.3), had lower expenditures than Current (US$5244, 95% CI 4707.9 to 5580.3) and Former (US$5590, 95% CI 5267.4 to 5913.5) smokers. CI for Current and Former smokers overlapped. Results were similarly significant when controlling for disease history. Years-since-quitting did not affect expenditures. In each decade of adult life, Former smokers had the highest annual medical expenditures, followed by Current and then Never smokers.
conclusionsWe updated annual medical expenditures during the Affordable Care Act era by smoking status using the current best practice model. While we identify Former smokers as having higher medical expenditures than Current smokers, we do not examine how care-seeking behaviour varies between levels of each risk factor.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.