Mendelian Randomization analysis of the causal effect of cigarette smoking on hospital costs
<p><strong>INTRODUCTION:</strong> Knowledge of the impact of smoking on healthcare costs is important for establishing the external effects of smoking and for evaluating policies intended to modify this behavior. Conventional analysis of this association is difficult because of omi...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Oxford University Press
2024
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| _version_ | 1811140061083729920 |
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| author | Dixon, P Sallis, H Munafo, M Davey Smith, G Howe, L |
| author_facet | Dixon, P Sallis, H Munafo, M Davey Smith, G Howe, L |
| author_sort | Dixon, P |
| collection | OXFORD |
| description | <p><strong>INTRODUCTION:</strong> Knowledge of the impact of smoking on healthcare costs is important for establishing the external effects of smoking and for evaluating
policies intended to modify this behavior. Conventional analysis of this association is difficult because of omitted variable bias, reverse causality, and measurement error.</p>
<br>
<p><strong>METHODS:</strong> We approached these challenges using
a Mendelian Randomization study design; genetic variants associated with
smoking behaviors were used in instrumental variables models with inpatient
hospital costs (calculated from electronic health records) as the outcome. We
undertook genome wide association studies to identify genetic variants
associated with smoking initiation and a composite smoking index (reflecting
cumulative health impacts of smoking) on up to 300,045 individuals (mean
age: 57 years at baseline, range 39 to 72 years) in the UK Biobank. We
followed individuals up for a mean of six years.</p>
<br>
<p><strong>RESULTS:</strong> Genetic liability to initiate smoking (ever versus never smoking) was estimated to increase mean per-patient annual inpatient hospital costs by £477 (95% confidence interval (CI): £187 to £766). A one-unit change in genetic liability to the
composite smoking index (range: 0-4.0) increased inpatient hospital costs by £204 (95% CI: £105 to £303) per unit increase in this index. There was some evidence that the composite smoking index causal models violated the instrumental variable assumptions, and all Mendelian Randomization models were estimated with considerable uncertainty. Models conditioning on risk tolerance were not robust to weak instrument bias.</p>
<br>
<p><strong>CONCLUSIONS:</strong> Our findings have implications for the potential cost-effectiveness of smoking interventions.</p> |
| first_indexed | 2024-04-23T08:26:18Z |
| format | Journal article |
| id | oxford-uuid:bcbf1bc9-fb19-4e1e-a337-26d7a1e9f4ee |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-09-25T04:15:59Z |
| publishDate | 2024 |
| publisher | Oxford University Press |
| record_format | dspace |
| spelling | oxford-uuid:bcbf1bc9-fb19-4e1e-a337-26d7a1e9f4ee2024-07-16T12:51:45ZMendelian Randomization analysis of the causal effect of cigarette smoking on hospital costsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:bcbf1bc9-fb19-4e1e-a337-26d7a1e9f4eeEnglishSymplectic ElementsOxford University Press2024Dixon, PSallis, HMunafo, MDavey Smith, GHowe, L<p><strong>INTRODUCTION:</strong> Knowledge of the impact of smoking on healthcare costs is important for establishing the external effects of smoking and for evaluating policies intended to modify this behavior. Conventional analysis of this association is difficult because of omitted variable bias, reverse causality, and measurement error.</p> <br> <p><strong>METHODS:</strong> We approached these challenges using a Mendelian Randomization study design; genetic variants associated with smoking behaviors were used in instrumental variables models with inpatient hospital costs (calculated from electronic health records) as the outcome. We undertook genome wide association studies to identify genetic variants associated with smoking initiation and a composite smoking index (reflecting cumulative health impacts of smoking) on up to 300,045 individuals (mean age: 57 years at baseline, range 39 to 72 years) in the UK Biobank. We followed individuals up for a mean of six years.</p> <br> <p><strong>RESULTS:</strong> Genetic liability to initiate smoking (ever versus never smoking) was estimated to increase mean per-patient annual inpatient hospital costs by £477 (95% confidence interval (CI): £187 to £766). A one-unit change in genetic liability to the composite smoking index (range: 0-4.0) increased inpatient hospital costs by £204 (95% CI: £105 to £303) per unit increase in this index. There was some evidence that the composite smoking index causal models violated the instrumental variable assumptions, and all Mendelian Randomization models were estimated with considerable uncertainty. Models conditioning on risk tolerance were not robust to weak instrument bias.</p> <br> <p><strong>CONCLUSIONS:</strong> Our findings have implications for the potential cost-effectiveness of smoking interventions.</p> |
| spellingShingle | Dixon, P Sallis, H Munafo, M Davey Smith, G Howe, L Mendelian Randomization analysis of the causal effect of cigarette smoking on hospital costs |
| title | Mendelian Randomization analysis of the causal effect of cigarette smoking on hospital costs |
| title_full | Mendelian Randomization analysis of the causal effect of cigarette smoking on hospital costs |
| title_fullStr | Mendelian Randomization analysis of the causal effect of cigarette smoking on hospital costs |
| title_full_unstemmed | Mendelian Randomization analysis of the causal effect of cigarette smoking on hospital costs |
| title_short | Mendelian Randomization analysis of the causal effect of cigarette smoking on hospital costs |
| title_sort | mendelian randomization analysis of the causal effect of cigarette smoking on hospital costs |
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