Examining the association of smoking with work productivity and associated costs in Japan

J Med Econ. 2017 Sep;20(9):938-944. doi: 10.1080/13696998.2017.1352507. Epub 2017 Jul 31.


Aims: Smoking is associated with significant health and economic burden globally, including an increased risk of many leading causes of mortality and significant impairments in work productivity. This burden is attenuated by successful tobacco cessation, including reduced risk of disease and improved productivity. The current study aimed to show the benefits of smoking cessation for workplace productivity and decreased costs associated with loss of work impairment.

Materials and methods: The data source was the 2011 Japan National Health and Wellness Survey (n = 30,000). Respondents aged 20-64 were used in the analyses (n = 23,738) and were categorized into: current smokers, former smokers, and never smokers. Generalized linear models controlling for demographics and health characteristics examined the relationship of smoking status with the Work Productivity and Activity Impairment questionnaire (WPAI-GH) endpoints, as well as estimated indirect costs.

Results: Current smokers reported the greatest overall work impairment, including absenteeism (i.e. work time missed) and presenteeism (i.e. impairment while at work); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on overall work impairment. Current smokers and former smokers had greater activity impairment (i.e. impairment in daily activities) than never smokers. Current smokers reported the highest indirect costs (i.e. costs associated with work impairment); however, after controlling for covariates, there were no significant differences between former smokers and never smokers on indirect costs.

Limitations and conclusions: Smoking exerts a large health and economic burden; however, smoking cessation attenuates this burden. The current study provides important further evidence of this association, with former smokers appearing statistically indistinguishable from never smokers in terms of work productivity loss and associated indirect costs among a large representative sample of Japanese workers. This report highlights the workplace benefits of smoking cessation across productivity markers and cost-savings.

Keywords: Activity impairment; Indirect costs; Smoking cessation; Work productivity.

MeSH terms

  • Absenteeism
  • Adult
  • Body Mass Index
  • Comorbidity
  • Cost of Illness*
  • Efficiency*
  • Female
  • Health Behavior
  • Health Surveys
  • Humans
  • Japan
  • Linear Models
  • Male
  • Middle Aged
  • Presenteeism
  • Smoking / economics*
  • Smoking Cessation / economics*
  • Socioeconomic Factors