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The Effects of Incremental Costs of Smoking and Obesity on Health Care Costs Among Adults: A 7-Year Longitudinal Study

Moriarty, James P. MSc; Branda, Megan E. MS; Olsen, Kerry D. MD; Shah, Nilay D. PhD; Borah, Bijan J. PhD; Wagie, Amy E. BS; Egginton, Jason S. MPH; Naessens, James M. ScD

Journal of Occupational and Environmental Medicine: March 2012 - Volume 54 - Issue 3 - p 286–291
doi: 10.1097/JOM.0b013e318246f1f4
Original Articles

Objective: To provide the simultaneous 7-year estimates of incremental costs of smoking and obesity among employees and dependents in a large health care system.

Methods: We used a retrospective cohort aged 18 years or older with continuous enrollment during the study period. Longitudinal multivariate cost analyses were performed using generalized estimating equations with demographic adjustments.

Results: The annual incremental mean costs of smoking by age group ranged from $1274 to $1401. The incremental costs of morbid obesity II by age group ranged from $5467 to $5530. These incremental costs drop substantially when comorbidities are included.

Conclusions: Obesity and smoking have large long-term impacts on health care costs of working-age adults. Controlling comorbidities impacted incremental costs of obesity but may lead to underestimation of the true incremental costs because obesity is a risk factor for developing chronic conditions.

From the Department of Health Sciences Research (Mr Moriarty, Mr Egginton, Ms Branda, Ms Wagie, and Drs Shah, Borah, and Naessens), and Division of Otorhinolaryngology (Dr Olsen) Mayo Clinic, Rochester, Minn.

Address correspondence to: James P. Moriarty, MSc, Department of Health Sciences Research, Mayo Clinic, 200 First St, SW, Rochester, MN 55905 (

The study was financially supported by Mayo Clinic.

©2012The American College of Occupational and Environmental Medicine