A new study shows that ACA tobacco rating rules aren’t enforced in employer plans.
Managed Healthcare Executive – Health Management
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Smokers twice as likely to develop debilitating skin disease
Tobacco smokers are twice as likely to develop a debilitating skin disease, according to new research published in the British Journal of Dermatology this week.
Hidradenitis suppurativa (HS) is a chronic and recurring inflammatory disease of the hair follicles, which causes a mixture of boil-like lumps, areas leaking pus, and scarring. It is estimated to affect around one per cent of the population, and it is difficult to predict the severity of individual cases and how they will respond to treatment.
The study was a retrospective cohort analysis, meaning that a database of medical records is examined to spot trends in a population’s health. The database that the researchers used has data on the health of over 50 million people in the United States, though for this study only patients with an active status in the database over the last three years who had race, gender, and age information, as well as at least one measurement for BMI with the study period were included. Patients who had already been diagnosed with HS before the start of the study were also excluded, as were patients who started smoking after they were diagnosed with HS.
Using this information the researchers were able to split the cohort into smokers and non-smokers and calculate the incidence of HS among both groups, taking into account other factors that influence HS incidence, such as age, gender, race, and obesity.
Of the 3,924,310 tobacco smokers, there were 7,860 patients diagnosed with HS during the study period, this compares to 8,430 cases of HS among 8,027,790 non-smokers. This equals an overall incidence among smokers of 0.20 per cent compared to 0.11 per cent among non-smokers.
Overall incidence was highest amongst the following smoking sub-groups: those aged 30-39 years (0.35 per cent); women (0.28 per cent); African Americans (0.46 per cent), and those with a BMI greater than, or equal to, 30 (0.33 per cent), qualifying them as obese.
Although the exact mechanisms linking tobacco smoking to HS are not understood, it has been speculated that nicotine has a role in triggering the disease.
Senior author, Dr Amit Garg, said: “This is the first population level evidence that tobacco smoking is a true risk factor for the development of Hidradenitis suppurativa. What is not yet understood is whether cessation of smoking can lead to improvement in disease activity.”
Matthew Gass of the British Association of Dermatologists said: “Hidradenitis suppurativa is a recurrent and painful disease, which can have an enormous physical and psychological impact on people, as such it is very important that medical professionals and patients understand the potential causes of this condition.
“This study also builds on the existing evidence base regarding the impact of smoking on skin health. There is already evidence that it is one of the biggest factors in skin ageing, and that it can increase the chances of acne scarring.”
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Refusal to treat obese patients and smokers: should this plan be put on hold?
In April of this year, the Vale of York clinical commissioning group (CCG) voiced their plans to make people wait for up to a year for treatment for non-life-threatening conditions such as hip and knee replacements if their body mass index is 30 or higher. The same restriction was to be put on smokers, with treatment being refused if they did not ditch the cigs. The decision incited a wave of criticism, with many stating that smokers and the obese are being seen as ‘easy targets’ and some going as far as comparing it to ‘racial discrimination.’ Following the backlash, the plans have been put on hold . When considering the future of the NHS however, was this really a step too far?
The cost
As we are all aware, the NHS is currently going through a period of uncertainty and strain, with budget cuts and insufficient staffing levels featuring heavily in headline news. With more cuts expected to take place over the next few years, it’s time to establish where money can be saved.
What is the cost of obesity?
The cost to the UK economy of overweight and obesity was estimated at £15.8 billion per year in 2007, including £4.2 billion in costs to the NHS. Taking into account the costs of treating obesity, lost earnings due to premature mortality and lost earnings due to attributable sickness among other things, the cost to society is predicted to rise to £50 billion by 2050.
What is the cost of smoking?
The cost of treating smokers in England was estimated at £2.7 billion in 2006 . Further to that there are costs in other areas such as the loss in productivity due to premature deaths (£4bn), cost to businesses of smoking breaks (£5.8bn), smoking-related sick days (£979m), social care costs of older smokers (£1.1bn) and the costs of fires caused by smokers’ materials (£259m).
What is the cost of routine operations?
Tim Wilton, president of the British Orthopedic Association, highlighted the cost of the most routine operations that smokers and obese patients were being refused:
He concluded that hip and knee replacements were very cheap for the NHS, costing an average of just £1 a day, ‘There is no clinical or value for money justification for refusing to fund hip or knee replacements based on BMI or smoker status,’ he added.
The true cost of smoking and obesity to your health
There is certainly a case to be made for encouraging a healthier lifestyle; however total refusal to treat those who are smokers or that are obese may not necessarily be the answer. With smoking and obesity being classed as two of the top contributors to life threatening illnesses and early deaths in the UK, it is time to assess the efforts we are making to live a healthy lifestyle to ensure we are caring for our bodies the best we can.
To learn more about how you can stop smoking, please read our blog which identifies 10 ways you can beat cigarette cravings. Please tell us what you think in the comments box below – we want to hear your thoughts.
If you are struggling with obesity and you want to talk with others and share tips and advice on how to shift the weight, please join in the conversation via the talkweight forum.