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The Relationship Between Smoking and Health Care, Workers' Compensation, and Productivity Costs for a Large Employer

Sherman, Bruce W. MD; Lynch, Wendy D. PhD

Journal of Occupational and Environmental Medicine: August 2013 - Volume 55 - Issue 8 - p 879–884
doi: 10.1097/JOM.0b013e31829f3129
Original Articles

Objective: To quantify and compare employee health- and productivity-related costs for current smokers versus nonsmokers for a large US employer.

Methods: Multivariate regression models were used to compare medical, pharmacy, workers' compensation, and short-term disability costs, self-reported absenteeism, and presenteeism by smoking status. Costs were aggregated over 3 years, from 2008 to 2010.

Results: Controlling for demographic variables, smokers had significantly different health care utilization patterns, as well as higher absenteeism and presenteeism costs. Overall, employees who smoke were estimated to cost employers $900 to $1383 more than their nonsmoking counterparts.

Conclusions: Current smokers experience incrementally greater lost productivity than nonsmokers, contributing to employer costs associated with smoking. Increased employer focus on smoking cessation may help mitigate these organizational costs.

From the Employers Health Coalition, Inc (Dr Sherman), Canton; Department of Medicine (Dr Sherman), Case Western Reserve University School of Medicine, Cleveland, Ohio; Lynch Consulting, Ltd (Dr Lynch), Steamboat Springs, Colo; and Altarum Institute (Dr Lynch), Ann Arbor, Mich.

Address correspondence to: Bruce W. Sherman, MD, 3175 Belvoir Blvd., Cleveland, OH 44122 (

This study was funded by a research grant from Pfizer for the statistical analysis (provided by Thomson Reuters/Truven) and manuscript preparation. Employers Health Coalition, Inc (EHCI) received payment from Pfizer, Inc, for this research. Dr. Lynch (Lynch Consulting, Ltd) received payment from EHCI as an independent contractor for supplemental analytics support and manuscript preparation. Dr Sherman (Sherman Consulting Services) received payment from EHCI as an independent contractor for study design and manuscript preparation while also serving as the EHCI medical director. Truven Health, Inc, received payment from EHCI as an independent contractor for performing statistical analysis related to the research.

Dr Sherman is currently a member of the speaker bureau for Abbott, Merck, and Pfizer. He has recently participated in advisory board meetings on behalf of Novo Nordisk, Merck, Eisai, Genentech, Bayer, and Allergan. He serves on the scientific advisory board for Humana and has received research funding from Sanofi and Pfizer. His recent speaking engagements with Pfizer have included unbranded presentations regarding the employer cost of smoking and value-based benefit design.

Dr Lynch has received speaking honoraria from multiple pharmaceutical firms, employer coalitions, and health insurance companies in the past. She is currently receiving consulting fees from Teladoc and Eliza corporations who may, among other services, encourage patients to quit smoking.

Authors Sherman and Lynch have no relationships/conditions/circumstances that present potential conflict of interest.

The JOEM editorial board and planners have no financial interest related to this research.

Copyright © 2013 by the American College of Occupational and Environmental Medicine