The economic costs of alcohol, tobacco and illicit drugs in Canada, 1992
TL;DR: The economic costs of alcohol, tobacco and illicit drugs in Canadian society in 1992 are estimated utilizing a cost-of-illness framework and recently developed international guidelines.
Abstract: Aims, design and setting. The economic costs of alcohol, tobacco and illicit drugs to Canadian society in 1992 are estimated utilizing a cost-of-illness framework and recently developed international guidelines. Measurements. For causes of disease or death (using ICD-9 categories), pooled relative risk estimates from meta-analyses are combined with prevalence data by age, gender and province to derive the proportion attributable to alcohol, tobacco and/or illicit drugs. The resulting estimates of attributable deaths and hospitalizations are used to calculate associated health care, law enforcement, productivity and other costs. The results are compared with other studies, and sensitivity analyses are conducted on alternative measures of alcohol consumption, alternative discount rates for productivity costs and the use of diagnostic-specific hospitalization costs. Findings. The misuse of alcohol, tobacco and illicit drugs cost more than $18.4 billion in Canada in 1992, representing $649 per capita or 2.7% of GDP. Alcohol accounts for approximately $7.52 billion in costs, including $4.14 billion for lost productivity, $1.36 billion for law enforcement and $1.30 billion in direct health care costs. Tobacco accounts for approximately $9.56 billion in costs, including $6.82 billion for lost productivity and $2.68 billion for direct health care costs. The economic costs of illicit drugs are estimated at $1.4 billion. Conclusions. Substance abuse exacts a considerable toll to Canadian society in terms of illness, injury, death and economic costs.
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TL;DR: The direct health care costs attributable to physical inactivity in Canada, the number of lives lost prematurely each year that are attributable to a sedentary lifestyle and the effect that a reduction of 10% in inactivity levels (a Canadian objective for 2003) could have on reducing direct health Care costs are estimated.
Abstract: Background: About two-thirds of Canadians are physically inactive. As a risk factor for several chronic diseases, physical inactivity can potentially be a substantial public health burden. We estimated the direct health care costs attributable to physical inactivity in Canada, the number of lives lost prematurely each year that are attributable to a sedentary lifestyle and the effect that a reduction of 10% in inactivity levels (a Canadian objective for 2003) could have on reducing direct health care costs. Methods: We calculated summary relative risk (RR) estimates from prospective longitudinal studies of the effects of physical inactivity on coronary artery disease, stroke, colon cancer, breast cancer, type 2 diabetes mellitus and osteoporosis. We then computed the population-attributable fraction (PAF) for each illness from the summary RR and the prevalence of physical inactivity (i.e., 62%) and applied the PAF to the total direct health care expenditures for 1999 and to the number of deaths in 1995 associated with each disease to determine the health care costs and lives lost prematurely that were directly attributable to physical inactivity. Results: About $2.1 billion, or 2.5% of the total direct health care costs in Canada, were attributable to physical inactivity in 1999. A sensitivity analysis (simultaneously varying each of the health care costs and PAF by ±20%) indicated that the costs could be as low as $1.4 billion and as high as $3.1 billion. About 21 000 lives were lost prematurely in 1995 because of inactivity. A 10% reduction in the prevalence of physical inactivity has the potential to reduce direct health care expenditures by $150 million a year. Interpretation: Physical inactivity represents an important public health burden in Canada. Even modest reductions in inactivity levels could result in substantial cost savings.
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TL;DR: Tobacco use was found to be the most important of 25 risk factors for developed countries in the comparative risk assessment underlying the data, and had the highest mortality risk of all the substance use categories, especially for the elderly.
Abstract: The use of alcohol, tobacco and illicit drugs entails considerable burden of disease: in 2000, about 4% of the global burden as measured in disability adjusted life years was attributable to each alcohol and tobacco, and 0.8% to illicit drugs. The burden of alcohol in the above statistic was calculated as net burden, i.e. incorporating the protective health effects. Tobacco use was found to be the most important of 25 risk factors for developed countries in the comparative risk assessment underlying the data. It had the highest mortality risk of all the substance use categories, especially for the elderly. Alcohol use was also important in developed countries, but constituted the most important of all risk factors in emerging economies. Alcohol use affected younger people than tobacco, both in terms of disability and mortality. The burden of disease attributable to the use of legal substances clearly outweighed the use of illegal drugs. A large part of the substance-attributable burden would be avoidable if known effective interventions were implemented.
357 citations
01 Jan 2005
273 citations
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TL;DR: The alcohol hangover has been well-known since at least Biblical times and in the workplace, the greatest cost incurred by alcohol is the decreased productivity of affected employees as a result of hangover-related absenteeism and poor job performance.
Abstract: Purpose To review the cause, pathophysiologic characteristics, cost, and treatment of alcohol-induced hangover. Data sources A MEDLINE search of English-language reports (1966 to 1999) and a manual search of bibliographies of relevant papers. Study selection Related experimental, clinical, and basic research studies. Data extraction Data in relevant articles were reviewed, and relevant clinical information was extracted. Data synthesis The alcohol hangover is characterized by headache, tremulousness, nausea, diarrhea, and fatigue combined with decreased occupational, cognitive, or visual-spatial skill performance. In the United States, related absenteeism and poor job performance cost $148 billion annually (average annual cost per working adult, $2000). Although hangover is associated with alcoholism, most of its cost is incurred by the light-to-moderate drinker. Patients with hangover may pose substantial risk to themselves and others despite having a normal blood alcohol level. Hangover may also be an independent risk factor for cardiac death. Symptoms of hangover seem to be caused by dehydration, hormonal alterations, dysregulated cytokine pathways, and toxic effects of alcohol. Physiologic characteristics include increased cardiac work with normal peripheral resistance, diffuse slowing on electroencephalography, and increased levels of antidiuretic hormone. Effective interventions include rehydration, prostaglandin inhibitors, and vitamin B6. Screening for hangover severity and frequency may help early detection of alcohol dependency and substantially improve quality of life. Recommended interventions include discussion of potential therapies and reminders of the possibility for cognitive and visual-spatial impairment. No evidence suggests that alleviation of hangover symptoms leads to further alcohol consumption, and the discomfort caused by such symptoms may do so. Therefore, treatment seems warranted. Conclusions Hangover, a common disorder, has substantial morbidity and societal cost. Appropriate management may relieve symptoms in many patients.
262 citations
TL;DR: This paper is one of the first attempts since 1985 to codify benefits of moderate alcohol consumption in epidemiological terms and finds positive findings in the areas of subjective health, mood enhancement, stress reduction, sociability, social integration, mental health, long-term cognitive functioning, and work income/disability.
258 citations