Tobacco use and the risk of catastrophic healthcare expenditure


  • Folashayo Adeniji University of Ibadan, Nigeria, Nigeria
  • Olayinka Lawanson University of Ibadan, Nigeria, Nigeria


catastrophic health expenditure, tobacco consumption, excess medical expenditure, out-of-pocket payment, healthcare financing, Nigeria


BACKGROUND: Tobacco consumption increases the chance that an individual will suffer from ill-health. Financial cost associated with increased demand for medical care can be substantial and catastrophic, especially for households in the lowest income stratum. This paper extends what is known about the poverty impact of tobacco use by estimating the increased risk of incurring higher catastrophic health expenditure because of tobacco consumption.
METHODS: The data for the study were drawn from the Harmonized Nigerian Living Standard Survey (HNLSS) conducted in 2009/2010 by the National Bureau of Statistics. Three log-linear models of health expenditures were used to predict the health expenditure attributable to tobacco consumption. The incidence of catastrophic health expenditure (CHE) was estimated using the standard 40-percent threshold of household total non-food expenditure.
RESULTS: Based on the three log-linear regression models, smokers had higher health expenditure compared to non-smokers (by 43.91%, 33.23% and 41.51%). Excess average health expenditure attributable to tobacco use was the highest among moderately poor smokers (Nigerian national currency Naira (NGN) 37,734.90 (USD251)) and the lowest among non-poor smokers (NGN 7,819.78 (USD52)). In addition, extremely poor smokers incurred higher medical expenditure attributable to tobacco use compared to non-poor smokers. Among the non-poor households, 23.87% experienced CHE in the rural areas and 13.62% in the urban ones. Accounting for the predicted excess medical expenditure among smokers, there was a 3.11% increase in the burden of CHE among households living in rural location. Overall, excess medical expenditure associated with tobacco use increased the incidence of CHE among households.
CONCLUSION: Essentially, smoking will aggravate the financial hardship of households because of higher burden of CHE in the short and long run. Therefore, healthcare policymakers in Nigeria can reduce the excessive financial burden attributable to smoking by developing policies that curtail tobacco consumption. Evidence provided in this study supports this.

Author Biography

Folashayo Adeniji, University of Ibadan, Nigeria

Department of Health Policy & Management


Abegunde, D. O., Mathers, C. D., Adam, T., Ortegon, M., & Strong, K. (2007). The burden and costs of chronic diseases in low-income and middle-income countries. The Lancet, 370(9603), 1929-1938.

Adeniji, F., Bamgboye, E., & van Walbeek, C. (2016). Smoking in Nigeria: Estimates from the Global Adult Tobacco Survey (GATS, 2012) Stroke, 2, 3.

Bobak, M., Jha, P., Nguyen, S., Jarvis, M., & Mundial, B. (2000). Poverty and smoking Tobacco control in developing countries (pp. 41-61): Oxford University Press.

Bonu, S., Rani, M., Peters, D. H., Jha, P., & Nguyen, S. N. (2005). Does use of tobacco or alcohol contribute to impoverishment from hospitalization costs in India? Health Policy and Planning, 20(1), 41-49.

Bovbjerg, R. R. (2001). Covering catastrophic health care and containing costs: preliminary lessons for policy from the US experience. World Bank LCSHD Paper.

Daneshkohan, A., Karami, M., Najafi, F., & Matin, B. K. (2011). Household catastrophic health expenditure. Iranian journal of public health, 40(1), 94.

Filmer, D., Hammer, J. S., & Pritchett, L. H. (2002). Weak links in the chain II: a prescription for health policy in poor countries. The World Bank Research Observer, 17(1), 47-66.

Fishman, P. A., Khan, Z. M., Thompson, E. E., & Curry, S. J. (2003). Health care costs among smokers, former smokers, and never smokers in an HMO. Health services research, 38(2), 733-749.

Gotsadze, G., Zoidze, A., & Rukhadze, N. (2009). Household catastrophic health expenditure: evidence from Georgia and its policy implications. BMC health services research, 9(1), 69.

Harrison, G. W., Feehan, J. P., Edwards, A. C., & Segovia, J. (2003). Cigarette smoking and the cost of hospital and physician care. Canadian Public Policy/Analyse de Politiques, 1-20.

Hasdai, D., Garratt, K. N., Grill, D. E., Lerman, A., & Holmes Jr, D. R. (1997). Effect of smoking status on the long-term outcome after successful percutaneous coronary revascularization. New England Journal of Medicine, 336(11), 755-761.

Herdman, R., Hewitt, M., & Laschober, M. (1993). Smoking-related deaths and financial costs: Office of Technology Assessment estimates for 1990. Paper presented at the Washington, DC, US Congress, Office of Technology Assessment.

John, R. M., Sung, H.-Y., Max, W. B., & Ross, H. (2011b). Counting 15 million more poor in India, thanks to tobacco. Tobacco control, tc. 2010.040089.

Kawabata, K., Xu, K., & Carrin, G. (2002). Preventing impoverishment through protection against catastrophic health expenditure. Bulletin of the World Health Organization, 80(8), 612-612.

Lightwood, J. M., & Glantz, S. A. (1997). Short-term economic and health benefits of smoking cessation. Circulation, 96(4), 1089-1096.

Liu, Y., Rao, K., Hu, T.-w., Sun, Q., & Mao, Z. (2006). Cigarette smoking and poverty in China. Social science & medicine, 63(11), 2784-2790.

National Bureau of Statistics. (2012). The Nigeria poverty profile 2010 report. Press Briefing By The Statistician-General.

Nwhator, S. O. (2012). Nigeria's costly complacency and the global tobacco epidemic. Journal of public health policy, 33(1), 16-33.

Russell, S., & Gilson, L. (1997). User fee policies to promote health service access for the poor: a wolf in sheep's clothing? International Journal of Health Services, 27(2), 359-379.

Sturm, R., An, R., Maroba, J., & Patel, D. (2013). The effects of obesity, smoking, and excessive alcohol intake on healthcare expenditure in a comprehensive medical scheme. SAMJ: South African Medical Journal, 103(11), 840-844.

Terry-McElrath, Y. M., O’Malley, P. M., & Johnston, L. D. (2017). Discontinuous Patterns of Cigarette Smoking From Ages 18 to 50 in the United States: A Repeated-Measures Latent Class Analysis. Nicotine & Tobacco Research, ntx074.

Wang, Y., Sung, H.-Y., Lightwood, J., Chaffee, B. W., Yao, T., & Max, W. (2017). Healthcare Utilization and Expenditures Attributable to Smokeless Tobacco Use among US Adults. Nicotine & Tobacco Research, ntx196.

World Health Organization, (2005). Designing health financing systems to reduce catastrophic health expenditure.

World Health Organization, (2009). World health statistics 2009: World Health Organization.

Xin, Y., Qian, J., Xu, L., Tang, S., Gao, J., & Critchley, J. A. (2009a). The impact of smoking and quitting on household expenditure patterns and medical care costs in China. Tobacco control, tc. 2008.026955.

Xin, Y., Qian, J., Xu, L., Tang, S., Gao, J., & Critchley, J. A. (2009b). The impact of smoking and quitting on household expenditure patterns and medical care costs in China. Tobacco control, 18(2), 150-155.

Xu, K., Evans, D. B., Kawabata, K., Zeramdini, R., Klavus, J., & Murray, C. J. (2003). Household catastrophic health expenditure: a multicountry analysis. The Lancet, 362(9378), 111-117.

Xu, X., Bishop, E. E., Kennedy, S. M., Simpson, S. A., & Pechacek, T. F. (2015). Annual healthcare spending attributable to cigarette smoking: an update. American journal of preventive medicine, 48(3), 326-333.






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